Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach

Otolaryngol Head Neck Surg. 2015 Oct;153(4):575-81. doi: 10.1177/0194599815596742. Epub 2015 Jul 27.


Objectives: Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care.

Study design: Cost-benefit analysis based on contingent valuation surveys.

Setting: An otolaryngology-specific ER in a tertiary care academic medical center.

Subjects and methods: Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework.

Results: The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343.

Conclusion: Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services.

Keywords: contingent valuation; cost-benefit analysis; emergency services; specialty emergency rooms; willingness to pay.

MeSH terms

  • Acute Disease
  • Child
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Emergency Service, Hospital / economics*
  • Female
  • Humans
  • Male
  • Massachusetts
  • Middle Aged
  • Otolaryngology / economics*
  • Patients / psychology
  • Socioeconomic Factors
  • Surveys and Questionnaires