Microlaryngoscopic surgery for T1 glottic lesions: a cost-effective option

Excision of squamous cell carcinoma of the vocal cord using microlaryngoscopy (ML) with or without laser is a cost-effective treatment option in highly selected patients. A retrospective review of 50 cases of invasive and microinvasive squamous cell carcinoma demonstrated a failure rate of 8% (4 patients), all of whom were successfully salvaged by hemilaryngectomy (1 patient) or irradiation (3 patients). Other treatment options for T1 glottic lesions include hemilaryngectomy or radiotherapy, yielding similar cure rates of 95% and 67% to 93%, respectively. Investigation of the potential savings by extrapolating 1992 health care costs into the treatment options for T1 glottic carcinoma resulted in costs of $12,956 per patient for ML, while hemilaryngectomy averaged $35,616 per patient and radiotherapy netted costs of $32,588 per patient. Extrapolating these costs to a theoretic group of 100 patients, ML provided savings of 2.4 million dollars when compared to the other treatment modalities. In selected patients, ML for T1 glottic cancer provides an effective therapeutic modality suited to our cost-conscious environment.