Laryngeal Biopsies in the Outpatient Setting Progressed to Full Appraisal by Health Technology Wales

‘Laryngeal biopsies in the Outpatient setting in people with suspected head and neck dysplasia/cancer’, a topic proposed by Olympus, has been progressed to full appraisal by Health Technology Wales following the publication of a Topic Exploration Report.

Health Technology Wales (HTW) research and evaluate the best available clinical and cost-effectiveness evidence about a health technology. Based on this evidence, HTW’s Appraisal Panel produces guidance on whether the health technology should be adopted for use in Wales. Whilst progression to full appraisal means a further, more critical review of the evidence will take place, it does not guarantee that guidance will be issued recommending adoption of a technology in Wales. More information about their Health Technology Appraisal (HTA) process can be found at: www.healthtechnology.wales/about/our-appraisal-process/   

Summary of the Available Evidence

The Topic Exploration Report provided an initial review of existing advice from respected bodies, such as the Scottish Health Technologies Group (SHTG) and National Institute for Health and Care Excellence (NICE), as well as multiple clinical studies.

The summary of evidence broadly categorises the available evidence into four categories: Diagnostic accuracy, Diagnostic work-up and time-to-treatment, Clinical Outcomes, Safety and Cost. Below are some of the findings in the existing evidence:

• The mean time from consultation to biopsy was 17.4 days for the operative endoscopy and 1.3 days for outpatient. [i]
• Diagnostic work-up times for outpatient flexible endoscopic biopsies were quicker compared to rigid laryngopharyngoscopy, with 16 days for rigid laryngopharyngoscopy, versus 2 days for flexible endoscopic biopsies. [ii]
• Time-to-treatment for outpatient flexible endoscopic biopsies were quicker than rigid laryngopharyngoscopy, with waiting times of 41.5 days for rigid laryngopharyngoscopy versus 27 days for flexible endoscopic biopsies. [ii]
• The SHTG found the average resource saving per annum over five years of implementing outpatient biopsies was in excess of £400,000 for NHS Scotland alone. [iii]
• A systematic review of 13 studies reported lower costs for outpatient endoscopic transnasal surgery when compared to theatre-based procedures. The costs of flexible endoscopic laryngopharyngeal biopsies ranged from €57 to €110, whereas costs for biopsies obtained under general anaesthetic varied between €822 and €1,101. [iv]
• Outpatient biopsy was generally found to be safe with low complication rates and the procedure appeared to be well-tolerated by most patients. [iii]

Better Outcomes for Everyone

Early detection and diagnosis, alongside timely intervention, is essential for improving outcomes for suspected cancer patients. The COVID-19 pandemic has had a marked impact on the ability of the healthcare system to deliver care, with both the number of patients awaiting treatment and waiting times for treatment, growing. The possibility of outpatient laryngeal biopsy reducing the time to diagnosis, whilst reducing healthcare costs and freeing valuable theatre capacity, has never been of greater value to the NHS and its patients.

“This appraisal represents a really positive step forward for patients with suspected laryngeal cancer. Outpatient biopsy not only has the potential to reduce the anxious wait that patients face for a confirmed diagnosis, but it can also avoid the need for a more invasive procedure under general anaesthetic, all whilst helping reduce costs for the healthcare system. We are delighted to see how Health Technology Wales seek to evaluate these innovative approaches, with the view to benefitting patients across Wales. We very much look forward to the results of the full appraisal.”

Alex Zervakis, General Manager

Health Economics & Market Access, Olympus UK & Ireland

To read the Topic Exploration Report on Laryngeal biopsies in the Outpatient setting in people with suspected head and neck dysplasia/cancer, published by Health Technology Wales, please head to: www.healthtechnology.wales/reports-guidance/outpatient-laryngeal-biopsy/ 

[i] Lee et al (2018)

[ii] Schutte et al (2018)

[iii] Healthcare Improvement Scotland

[iv] Schimberg et al (2019)