Cost‐effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

Abstract

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

Symptom Outcomes After Sialendoscopy‐Assisted Salivary Duct Surgery: A Prospective 6‐Year Study

“…As in prior studies, we defined mild disease and/or complete symptomatic resolution as COSS scores <10, moderate disease and/or partial symptomatic resolution as COSS scores 10-25, and severe disease and/or symptomatic non-resolution as COSS scores >25. [1][2][3][4] We defined worsening of a symptom resolution category as a change in symptom category from complete resolution (COSS score <10) to partial resolution (COSS score [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] or non-resolution (COSS score >25), or from partial resolution to non-resolution. Improvement of the resolution category was defined as the opposite.…”

“…Furthermore, despite the high upfront costs and training required in establishing a practice, these minimally invasive approaches to treat salivary obstruction have been shown to be a cost-effective alternative to sialadenectomy. 11 Long term efficacy of salivary gland-preserving surgery for chronic sialadenitis has been under-reported on a prospective basis in the medical literature. We present a longitudinal prospective cohort study assessing patientreported symptoms associated with chronic obstructive sialadenitis over a median and mean of 6-years of followup time.…”

“…A combined surgical approach may involve sialodochotomy (open incision into the duct), sialodochoplasty (suturing the duct open to create a new ostium), or a transfacial incision for access for a parotid sialolithotomy. Furthermore, despite the high upfront costs and training required in establishing a practice, these minimally invasive approaches to treat salivary obstruction have been shown to be a cost‐effective alternative to sialadenectomy 11 …”

Suture Stenting After Sialendoscopy: A Novel Technique That Reduces Risk of Recurrent Parotitis

“…Recurrent infections and symptoms lead to decreased quality of life symptom scores, increased clinic visits and hospitalizations, and increased health care costs. [1][2][3] Sialadenitis management is comprised of both medical and surgical management. Medical management includes conservative measures that encourage salivary egress to limit stagnant flow that can lead to infections as well as antibiotic therapy for acute salivary gland infections.…”

“…While its incidence is rare, with estimates around 1 in 10,000–30,000, 1 it can have a debilitating effect on patients. Recurrent infections and symptoms lead to decreased quality of life symptom scores, increased clinic visits and hospitalizations, and increased health care costs 1–3 …”