Evaluation of Societal Health Utility of Facial Palsy and Facial Reanimation

Abstract

IMPORTANCE The severity of a health state may be quantified using health utility measures. The utility of flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome with synkinesis may be challenging to discern from photographs alone. OBJECTIVE To determine the societal health utility of flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, and post-facial reanimation using standard video. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted at the Massachusetts Eye and Ear and the Harvard Decision Science Laboratory from June 14, 2017, to August 3, 2017. Healthy adult naïve observers were recruited through advertising in the Cambridge, Massachusetts, area. Participants (n = 298) completed the web-based, interactive survey in person. The survey comprised clinical vignettes consisting of symptom summaries, videos, and pictures depicting 5 health states. MAIN OUTCOMES AND MEASURES Adult naïve observers ranked the utility of 5 randomized health states (flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, post-facial reanimation, monocular blindness, and binocular blindness) according to the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) measures. Standard videos of patients' facial function were used. RESULTS In total, 377 naïve observers were recruited and completed the survey in its entirety. Of the 377 participants, 298 (79.0%) were included for analysis. Among the 298 participants, 151 (50.7%) were female, 146 (49.0%) were male, with a mean (SD) age of 33.0 (15.1) years. No differences in health utility scores (SD) were observed between flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome (

The health utility of mild and severe dysphonia

“…Given the exponentially increasing costs of medical care in the United States and abroad, there has been growing interest in evaluating health utility across medical specialties . Health utility values have been measured for a variety of conditions within otolaryngology, including head and neck cancer, facial paralysis, hearing loss, and chronic rhinosinusitis . Within laryngology, where surgical therapies often affect quality of life rather than life span, there is increasing focus on assessing the cost‐effectiveness of laryngeal surgery .…”

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“…[14][15][16] It is recommended that assessment with other methods, like standard gamble (SG) and time-tradeoff (TTO), also be used for validation. 34 These methods incorporate the need for decision-making under uncertainty, which is more realistic but not required by the method used in the present study, which some authors argue is not a pure measure of utility. 12 Conversely, simple assessments may have important advantages in terms of usability and performance.…”

“…While there are several methods of directly eliciting health utility values, this study only used one method, and is most similar to a “feeling thermometer” or visual analog scale (VAS) . It is recommended that assessment with other methods, like standard gamble (SG) and time‐tradeoff (TTO), also be used for validation . These methods incorporate the need for decision‐making under uncertainty, which is more realistic but not required by the method used in the present study, which some authors argue is not a pure measure of utility .…”

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