Compliance and efficiency before and after implementation of a clinical practice guideline for laryngeal carcinomas

Michel Van Agthoven, Hélène A.G. Heule-Dieleman, Paul P. Knegt, Johannes H.A.M. Kaanders, Robert J. Baatenburg De Jong, Bernd Kremer, C. René Leemans, Henri A.M. Marres, Johannes J. Manni, Johannes A. Langendijk, Peter C. Levendag, Reina E. Tjho-Heslinga, Joseph M.A. De Jong, Maarten F. De Boer, Carin A. Uyl-De Groot

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8 Citations (Scopus)


We evaluated whether the implementation of a nationwide clinical practice guideline for diagnosis, treatment and follow-up of laryngeal carcinomas led to changes in hospital costs, balanced against clinical changes observed following the guideline's implementation. Charts of 822 patients with larynx carcinoma (459 treated before the introduction of the guideline and 363 thereafter) in five hospitals were retrospectively investigated. In all phases, no differences in total hospital costs were observed after the guideline's implementation. Total mean costs were € 3,207 (95%CI 3,091-3,395) for diagnosis, € 3,169 (2,153-4,182), € 5,026 (3,996-6,057), € 6,458 (5,579-7,337), € 8,037 (7,469-8,606), € 12,765 (10,763-14,769), € 19,227 (16,848-21,605) for treatment of dysplasia, carcinoma in situ, T1, T2, T3 and T4 carcinoma, respectively, and € 1,856 (1,491-2,220) for 1 year disease-free follow-up. In an earlier study, we observed several positive changes after the guideline's implementation. Balanced against the equal costs before and after the guideline's implementation, we conclude that the efficiency of the care process improved.

Original languageEnglish
Pages (from-to)729-737
Number of pages9
JournalEuropean Archives of Oto-Rhino-Laryngology
Issue number8
Publication statusPublished - Aug 2006


  • Compliance
  • Guideline adherence
  • Health care costs
  • Laryngeal neoplasms
  • Larynx cancer

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