Cost-effectiveness of Scan-directed Parathyroidectomy

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2008 Aug 2

PMID 18670746

Citations 4

Authors

Radu Mihai

Mary Weisters

Michael J Stechman

Fergus Gleeson

Greg Sadler

Affiliations

Soon will be listed here.

Abstract

Background: Concordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT).

Aim: To investigate the financial implications of scan-directed parathyroid surgery.

Methods: Analysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre.

Results: Two hundred patients (138F:62M, age 18-91years) were operated for non-familial PHPT between Jan 2003 and Oct 2007. MIP was performed in 129 patients, with a mean operative time was 35 +/- 18min. Some 75 patients were discharged the same day and the others had a total of 72 in-patient days. Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58 +/- 25min. Only nine patients were discharged the same day and a total of 93 in-patient days were used ( approximately 1.3days/patient). The estimated total costs incurred were pound215,035 ( approximately 290,000<euro>). These costs would have been covered by the National Tariff ( pound2,170 per parathyroidectomy) but were higher than those possibly incurred if all 200 patients would have undergone BNE without any radiological investigations ( pound166,000 approximately 224,100euro).

Conclusion: Shorter operative time and day-case admission for MIP generate costs savings that compensate only partially for the additional costs associated with parathyroid imaging studies.

Citing Articles

Comparative Diagnostic Performance of Ultrasonography and 99mTc-Sestamibi Scintigraphy for Parathyroid Adenoma in Primary Hyperparathyroidism; Systematic Review and Meta- Analysis.

Moghadam R, Amlelshahbaz A, Namiranian N, Sobhan-Ardekani M, Emami-Meybodi M, Dehghan A Asian Pac J Cancer Prev. 2017; 18(12):3195-3200.

PMID: 29281866 PMC: 5980870. DOI: 10.22034/APJCP.2017.18.12.3195.

Preoperative localization strategies for primary hyperparathyroidism: an economic analysis.

Lubitz C, Stephen A, Hodin R, Pandharipande P Ann Surg Oncol. 2012; 19(13):4202-9.

PMID: 22825773 PMC: 3680347. DOI: 10.1245/s10434-012-2512-2.

Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients.

Bergenfelz A, Jansson S, Wallin G, Martensson H, Rasmussen L, Eriksson H Langenbecks Arch Surg. 2009; 394(5):851-60.

PMID: 19618204 DOI: 10.1007/s00423-009-0540-6.

Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations.

Mihai R, Barczynski M, Iacobone M, Sitges-Serra A Langenbecks Arch Surg. 2009; 394(5):785-98.

PMID: 19554347 DOI: 10.1007/s00423-009-0529-1.

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