Lag in Specialized Larynx Care Drives up Costs

Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, diagnosis and treatment is often delayed—at a cost. Duke and other otolaryngology researchers conducted a retrospective analysis of more than one-quarter of a million patients to learn how the amount of time from first primary care visit to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders.

The researchers reviewed records in a large, national administrative claims database and published their findings in the April 2015 issue of American Journal of Medicine. All patients included in the analysis had a diagnosis of a laryngeal/voice disorder as coded by the International Classification of Diseases, 9th Revision. They had to have first seen a primary care physician and later an otolaryngologist on an outpatient basis. The database had to contain at least 6 months of follow-up data after the first otolaryngology evaluation.

Researchers measured the total outpatient health care costs that had accrued from the first primary care outpatient visit to 6 months after the first otolaryngology visit.

Of the 260,095 unique patients who saw a primary care physician as an outpatient for a laryngeal/voice disorder, 8,999 (3.5%) later saw an otolaryngologist and acquired 6 months of follow-up data.

The data for this group of patients showed an increase in costs that tracked with the increasing amount of time between the primary care and otolaryngology appointment. A generalized linear regression model revealed that, compared with patients who saw an otolaryngologist within the first month of the initial primary care visit, patients who saw their specialist later in the process (>1 to 3 months or > 3 months after the initial primary care appointment) had relative mean cost increases of $271.34 (95% confidence interval, $115.95-$426.73) and $711.38 (95% confidence interval, $428.43-$993.34), respectively.

“Increased time from the first primary care visit to the first otolaryngology evaluation is associated with increased outpatient health care costs in patients with laryngeal/voice disorders,” says lead study author Seth Cohen, MD, MPH, in the Duke Division of Otolaryngology Head & Neck Surgery.  "Additional research is essential to help primary care physicians identify the patients who do require early otolaryngology referral, thereby improving the evaluation and management of laryngeal and voice disorder patients. It appears that cost savings could be captured through earlier referral.”

The study authors also noted that a longer wait between an initial physician visit and a pathologic diagnosis of laryngeal cancer has an adverse impact on overall and disease-specific survival. Previous studies (Hoare et al) have reported that primary care physicians may not be as accurate in diagnosing laryngeal cancer as otolaryngologists. Incorrect diagnoses often included acute laryngitis or nonspecific dysphonia, which may lead to associated costs for inappropriate treatment and a delay in diagnosing a serious, worsening disease. Laryngeal/voice disorders also have significant negative effects on patient quality of life, and earlier treatment may improve patient function with respect to communication.