Cost-effectiveness of scan-directed parathyroidectomy.
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).


OBJECTIVE
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).


CONCLUSIONS
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.
Mihai
Radu
R
Department of Surgery-level 2, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. radumihai@doctors.org.uk
Weisters
Mary
M
Stechman
Michael J
MJ
Gleeson
Fergus
F
Sadler
Greg
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D009313:National Health Programs / Q000191:economics; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D016105:Parathyroidectomy / Q000191:economics*; D011877:Radionuclide Imaging / Q000191:economics*; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography / Q000191:economics*; D055815:Young Adult
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi