Prophylactic Replacement of Voice Prosthesis | 185 7 for the treating physician or SLP. On the other hand, replacing VPs too early would implicate that patients need extra VPs and thus visit the clinics more often which would increase costs. The total costs of VPs and their replacements are very variable and depend on e.g., the type of VP used, hospital costs, number and type of healthcare professionals involved, travel expenses, and the healthcare system. Therefore, a costs analysis is not made. Data on complications of leakage, such as aspiration pneumonia, was not available in our database, though they are important for decision-making in VP replacements. The review of Hutcheson et al. gives a nice overview of pneumonia rates in laryngectomized patients. They state that an aspiration pneumonia due to leakage is relatively rare, but it could have serious (fatal) consequences21. In Poland, there is an ongoing randomized controlled trial comparing the effect of replacement of VPs every three months to a Wait-to-Leak policy, investigating complications, fistula colonization, and patient satisfaction22. Results are not yet available. If their results show fewer leakages in the replacement arm and comparable or fewer complications and high patient satisfaction, this might be a step in prophylactic replacement of VPs. Limitations The concept of PVPR in this paper is hypothetical. Our results are based on analysis in a retrospective dataset and Monte-Carlo simulations, mainly investigating regular Provox VPs. It is well known that also other brands of VPs suffer from an inconsistent device lifetime16, so it is unlikely that prophylactic replacement is an option for other brands. We have only investigated a cut-off point of 70%, because of reached consensus on the profitability for patients.
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