title: The cost-effectiveness of additional preoperative ultrasonography or sestamibi-SPECT in patients with primary hyperparathyroidism and negative findings on sestamibi scans.
abstract: OBJECTIVE
  To determine whether the use of additional preoperative imaging was cost-effective compared with bilateral neck exploration (BNE) for the treatment of primary hyperparathyroidism in patients with negative findings on scans with technetium Tc 99m sestamibi.
  
  
  METHODS
  We performed a cost-effectiveness analysis. The decision whether to proceed to BNE or obtain additional preoperative imaging using ultrasonography (US) or single-photon emission computed tomography with technetium Tc 99m sestamibi (SPECT) was modeled using decision analysis. We obtained probabilities of cure, detection of pathologic glands, and the correct side of the neck from recent literature.
  
  
  METHODS
  Expected cost, cure rate, and the incremental cost per cured case using the preoperative imaging strategies compared with BNE.
  
  
  RESULTS
  The US strategy dominated the SPECT and BNE strategies, with a lower expected cost (USD $6030 vs USD $7131 and $8384, respectively) and a greater expected cure rate (99.42% vs 99.26% and 97.69%, respectively). Threshold analysis suggests that the preoperative imaging strategies continued to dominate unless the cost of BNE was less than USD $5400 or the cost of unilateral neck exploration exceeded USD $6500. The US strategy dominated SPECT as a preoperative imaging strategy if the cost of SPECT exceeded $12 or the cost of a US test was less than $1300.
  
  
  CONCLUSIONS
  For the treatment of primary hyerparathyroidism in the patient with negative findings on technetium Tc 99m sestamibi scans, a strategy that uses additional preoperative US imaging appears to be cost-effective compared with SPECT or BNE.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Ruda
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Stack
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D015233:Models, Statistical; D016105:Parathyroidectomy; D011300:Preoperative Care / Q000191:economics* / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics*; D014463:Ultrasonography; D014481:United States
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi