{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T07:28:00Z","timestamp":1777620480913,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,9,7]],"date-time":"2016-09-07T00:00:00Z","timestamp":1473206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To evaluate the cost\u2010effectiveness of routine computed tomography (CT) in individuals with unilateral vocal fold paralysis (UVFP)<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Health Economics Decision Tree Analysis<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A decision tree was constructed to determine the incremental cost\u2010effectiveness ratio (ICER) of CT imaging in UVFP patients. Univariate sensitivity analysis was utilized to calculate what the probability of having an etiology of the paralysis discovered would have to be to make CT with contrast more cost\u2010effective than no imaging. We used two studies examining findings in UVFP patients. The decision pathways were utilizing CT neck with intravenous contrast after diagnostic laryngoscopy versus laryngoscopy alone. The probability of detecting an etiology for UVFP and associated costs were extracted to construct the decision tree. The only incorrect diagnosis was missing a mass in the no\u2010imaging decision branch, which rendered an effectiveness of 0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ICER of using CT was $3,306, below most acceptable willingness\u2010to\u2010pay (WTP) thresholds. Additionally, univariate sensitivity analysis indicated that at the WTP threshold of $30,000, obtaining CT imaging was the most cost\u2010effective choice when the probability of having a lesion was above 1.7%. Multivariate probabilistic sensitivity analysis with Monte Carlo simulations also showed that at the WTP of $30,000, CT scanning is more cost\u2010effective, with 99.5% certainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Particularly in the current healthcare environment characterized by increasing consciousness of utilization defensive medicine, economic evaluations represent evidence\u2010based findings that can be employed to facilitate appropriate decision making and enhance physician\u2010patient communication. This economic evaluation strongly supports obtaining CT imaging in patients with newly diagnosed UVFP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2c. <jats:italic>Laryngoscope<\/jats:italic>, 2016 127:440\u2013444, 2017<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26152","type":"journal-article","created":{"date-parts":[[2016,9,7]],"date-time":"2016-09-07T12:46:00Z","timestamp":1473252360000},"page":"440-444","source":"Crossref","is-referenced-by-count":19,"title":["Cost\u2010effectiveness of routine computed tomography in the evaluation of idiopathic unilateral vocal fold paralysis"],"prefix":"10.1002","volume":"127","author":[{"given":"Houmehr","family":"Hojjat","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter F.","family":"Svider","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam J.","family":"Folbe","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"},{"name":"Barbara Ann Karmanos Cancer Institute Detroit Michigan U.S.A"},{"name":"Department of Neurosurgery Wayne State University School of Medicine Detroit Michigan U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed N.","family":"Raza","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"},{"name":"Barbara Ann Karmanos Cancer Institute Detroit Michigan U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Carron","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"},{"name":"Surgical Service, Section of Otolaryngology John D. Dingell VA Medical Center Detroit Michigan U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahdi A.","family":"Shkoukani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"},{"name":"Barbara Ann Karmanos Cancer Institute Detroit Michigan U.S.A"},{"name":"Surgical Service, Section of Otolaryngology John D. Dingell VA Medical Center Detroit Michigan U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert L.","family":"Merati","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Washington School of Medicine Seattle Washington U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross M.","family":"Mayerhoff","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Wayne State University School of Medicine Detroit Michigan U.S.A"},{"name":"Barbara Ann Karmanos Cancer Institute Detroit Michigan U.S.A"},{"name":"Surgical Service, Section of Otolaryngology John D. 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