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Surgery versus Imaging in Non‐Localizing Primary Hyperparathyroidism: A Cost‐Effectiveness Model
Author(s) -
Frank Ethan,
Watson WayAnne,
Fujimoto Shan,
De Andrade Filho Pedro,
Inman Jared,
Simental Alfred
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28566
Subject(s) - medicine , primary hyperparathyroidism , parathyroidectomy , radiology , ultrasound , cost effectiveness , hyperparathyroidism , nuclear medicine , surgery , parathyroid hormone , risk analysis (engineering) , calcium
Objective To determine whether advanced imaging is cost‐effective compared to primary bilateral neck exploration in the management of non‐localizing primary hyperparathyroidism. Study Design Cost‐effectiveness analysis. Methods Cost‐effectiveness analysis based on decision tree model and available Medicare financial data using data from 347 consecutive patients having parathyroidectomy for primary hyperparathyroidism with either 1) positive, concordant ultrasound and sestamibi or 2) negative sestamibi and negative ultrasound. Results Bilateral neck exploration (BNE) costs $9578 and has a success rate of 97.3%. Single photon emission computed tomography (SPECT) + minimally invasive parathyroidectomy (MIP) was modeled to have a total cost of $8197 with a success rate of 98.6%. SPECT/computed tomography (CT) + MIP was modeled to have a total cost of $8271 and a 98.9% success rate. Four‐dimensional (4D)–CT + MIP was modeled to cost $8146 with a success rate of 99%. Incremental cost‐effectiveness ratios (IECR) (as compared to BNE) were −536.1, −605.5, and −701.6 ($/percent cure rate) for SPECT, SPECT/CT, and 4D‐CT respectively. One‐way sensitivity analyses demonstrate the change in IECR and cut‐off points (IECR = 0) for four major variables. Conclusions In patients with non‐localizing primary hyperparathyroidism, advanced imaging is associated with cost‐savings compared to routine bilateral neck exploration. Increased cost‐savings were predicted with increased imaging accuracy and decreased imaging costs. Increasing time for BNE or decreasing time for MIP were associated with increased cost savings. Level of Evidence III Laryngoscope , 2020