Cost-effectiveness of scan-directed parathyroidectomy.

Journal article

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). 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.

Authors: Mihai, R; Weisters, M; Stechman, M; Gleeson, F; Sadler, G

• Publication status: Published
• Journal: Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie
• Volume: 393
• Issue: 5
• Pages: 739-743
• Publication date: 2008-09-01
• DOI: 10.1007/s00423-008-0383-6
• EISSN: 1435-2451
• ISSN: 1435-2443
• Language: English
• Keywords: Adolescent; Cohort Studies; Parathyroid Hormone; Surgical Procedures, Minimally Invasive; Hyperparathyroidism, Primary; Neoplasms, Multiple Primary; Parathyroidectomy; Aged; Humans; Technetium Tc 99m Sestamibi; Cost-Benefit Analysis; Sensitivity and Specificity; Adult; Female; Male; Hospital Costs; Radionuclide Imaging; Young Adult; Length of Stay; Parathyroid Neoplasms; Aged, 80 and over; Ultrasonography; National Health Programs; Middle Aged