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Economic Burden of Induced Laryngeal Obstruction in Adolescents and Children
Robert Brinton Fujiki1, Tadeas Lunga1, David O Francis1
1Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.
Insights
Diagnosing pediatric induced laryngeal obstruction (ILO) incurs significant costs, with expenses decreasing after diagnosis. Socioeconomic factors influence cost sources but not total expenditure.
Area of Science:
- Pediatric Otolaryngology
- Health Economics
- Public Health
Background:
- Pediatric induced laryngeal obstruction (ILO) diagnosis is complex, often requiring specialist settings and multiple provider visits.
- The financial burden associated with diagnosing and treating pediatric ILO, particularly concerning socioeconomic disadvantage, is not well-understood.
Purpose of the Study:
- To examine the financial burden of diagnosing and treating pediatric ILO.
- To investigate the relationship between socioeconomic disadvantage and the costs associated with pediatric ILO.
Main Methods:
- Retrospective analysis of 113 pediatric patients diagnosed with ILO using the University of Madison Voice and Swallow Outcomes Database.
- Calculation of expenditures for pre-diagnosis (dyspnea-related visit to diagnosis) and post-diagnosis (first year) periods.
- Utilized the Area Deprivation Index (ADI) to assess socioeconomic status and its impact on costs.
Main Results:
- Total pre-diagnosis costs averaged $6486.93, decreasing to $2067.69 post-diagnosis.
- Patients underwent an average of 3 procedures and 5 office visits before diagnosis.
- While cost sources varied by socioeconomic status (fewer procedures, more medication in disadvantaged areas), overall expenditures did not differ significantly based on ADI.
Conclusions:
- Pediatric ILO presents a substantial financial challenge.
- Socioeconomic status influences the types of healthcare utilized for ILO, but not the total financial impact.
- Further research is needed to enhance diagnostic and management efficiency and equity for pediatric ILO patients.
Purpose:
Diagnosing pediatric induced laryngeal obstruction (ILO) requires equipment typically available in specialist settings, and patients often see multiple providers before a diagnosis is determined. This study examined the financial burden associated with the diagnosis and treatment of ILO in pediatric patients with reference to socioeconomic disadvantage.
Methods:
Adolescents and children (<18 years of age) diagnosed with ILO were identified through the University of Madison Voice and Swallow Outcomes Database. Procedures, office visits, and prescribed medications were collected from the electronic medical record. Expenditures were calculated for two time periods (1) pre-diagnosis (first dyspnea-related visit to diagnosis), and (2) the first year following diagnosis. The Area Deprivation Index (ADI) was used to estimate patient socioeconomic status to determine if costs differed with neighborhood-level disadvantage.
Results:
A total of 113 patients met inclusion criteria (13.9 years, 79% female). Total pre-diagnosis costs of ILO averaged $6486.93 (SD = $6604.14, median = $3845.66) and post-diagnosis costs averaged $2067.69 (SD = $2322.78; median = $1384.12). Patients underwent a mean of 3.01 (SD = 1.9; median = 2) procedures and 5.8 (SD = 4.7; median = 5) office visits prior to diagnosis. Pharmaceutical, procedure/office visit, and indirect costs significantly decreased following diagnosis. Patients living in neighborhoods with greater socioeconomic disadvantage underwent fewer procedures and were prescribed more medication than those from more affluent areas. However, total expenditures did not differ based on ADI.
Conclusions:
Pediatric ILO is associated with considerable financial costs. The source of these costs, however, differed according to socioeconomic advantage. Future work should determine how ILO diagnosis and management can be more efficient and equitable across all patients. Laryngoscope, 134:3384-3390, 2024.
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