title: Cost implications of different surgical management strategies for primary hyperparathyroidism.
abstract: BACKGROUND
  Controversy exists about optimal management of patients with primary hyperparathyroidism. To date, no studies have explored the cost implications of variation in practice.
  
  
  METHODS
  Results from a national survey of endocrine surgeons were combined with results from a survey of endocrinologists and financial data from Medicare. Patterns of use of resources were identified, annual costs for the surgical management of primary hyperparathyroidism in the United States were calculated, and the financial impact of variation in practice was estimated.
  
  
  RESULTS
  Survey respondents (n = 109) were experienced endocrine surgeons, performing an average of 33 parathyroidectomies annually. Seventy-five percent of patients undergo localization before initial exploration for primary hyperparathyroidism. In order of preference, these studies were sestamibi (43%), ultrasonography (28%), and sestamibi with single-photon emission computed tomography (26%). Although there is variation in preoperative and postoperative practice, in-hospital costs have the greatest influence on total cost. An estimated $282 million is spent annually in the United States on operations for primary hyperparathyroidism. National health expenditures could range by more than $70 million, depending on whether management strategies involving low or high use of resources are employed.
  
  
  CONCLUSIONS
  Substantial variation among endocrine surgeons in the management of primary hyperparathyroidism has important cost implications. Implementation of evidence-based guidelines to optimize clinical and economic performance should be considered.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Sosa
authors.forename: N R
authors.initials: NR
authors.lastname: Powe
authors.forename: M A
authors.initials: MA
authors.lastname: Levine
authors.forename: H M
authors.initials: HM
authors.lastname: Bowman
authors.forename: M A
authors.initials: MA
authors.lastname: Zeiger
authors.forename: R
authors.initials: R
authors.lastname: Udelsman
mesh_terms: D005260:Female; D017048:Health Care Costs; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D011795:Surveys and Questionnaires