Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism.
BACKGROUND
Controversy exists concerning the best treatment for asymptomatic primary hyperparathyroidism (PHPT) when the National Institutes of Health consensus conference criteria for parathyroidectomy are not met. We hypothesized that parathyroidectomy would be more cost-effective than observation or pharmacologic therapy for these patients.


METHODS
Cost-effectiveness analysis was performed comparing treatment strategies for asymptomatic PHPT. Treatment outcomes, their probabilities, and costs were identified on the basis of literature and cost database review. Outcomes were weighted by using established quality-of-life utility factors. Sensitivity analysis was used to examine the uncertainty of costs and utility estimates in the model.


RESULTS
The incremental cost-effectiveness ratio for parathyroidectomy was US dollars 4778 per quality-adjusted life year (QALY) gained. Operation remained cost-effective until the average cost of parathyroidectomy increased from the estimated value of US dollars 4778 to US dollars 14,650. Pharmacologic therapy was not cost-effective unless the annual cost of therapy decreased from an estimated US dollars 7406 (for cinacalcet) to US dollars 221. Parathyroidectomy ceases to be preferred over monitoring if a quality-of-life difference is not demonstrable after curative operation.


CONCLUSIONS
Parathyroidectomy is more cost-effective than observation for managing asymptomatic PHPT patients who do not meet National Institutes of Health criteria for parathyroidectomy. Furthermore, pharmacologic therapies with a greater than US dollars 221 annual cost were not cost-effective in this model.
Zanocco
Kyle
K
Department of Surgery, Division of Gastrointestinal & Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Angelos
Peter
P
Sturgeon
Cord
C
D000069449:Cinacalcet; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis / Q000379:methods; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy / Q000191:economics* / Q000601:surgery*; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D009281:Naphthalenes / Q000627:therapeutic use; D016105:Parathyroidectomy / Q000191:economics*; D018579:Patient Selection; D019057:Quality-Adjusted Life Years
D009281:Naphthalenes; D000069449:Cinacalcet