title: Financial and clinical implications of low-energy CT combined with 99m Technetium-sestamibi SPECT for primary hyperparathyroidism.
abstract: BACKGROUND
  (99m)Technetium-sestamibi hybrid SPECT/CT has been favored over conventional SPECT in preoperative evaluation of primary hyperparathyroidism (PHPT) patients. However, the financial implications of CT-image acquisition have never before been published. This prompted us to perform a cost analysis of the aforementioned nuclear procedures.
  
  
  METHODS
  A total of 55 PHPT patients operated on between 2004 and 2009 were studied. Overall, 27 patients underwent SPECT and 28 SPECT/CT. Localization results, as well as diagnostic and clinical cost variations between SPECT and SPECT/CT patients, were compared.
  
  
  RESULTS
  SPECT/CT revealed higher sensitivity than SPECT (96.7 vs 79.3%; P = .011), as well as higher specificity (96.4 vs 82.4%; P = .037) and positive predictive value (PPV) (96.7 vs 83%; P = .038) for correctly identifying the neck-side affected by PHPT. Likewise, SPECT/CT disclosed higher sensitivity (86.7 vs 61.1%; P < .0001), specificity (97.4 vs 90%; P = .022), and PPV (86.7 vs 65.7%; P = .0001) for correct neck-quadrant identification. The mean operative time decreased from 62 min following SPECT to 36 min following SPECT/CT (P < .0001), yielding a mean surgical expense saving of 109.9 <euro>/patient (updated at 2009/2010 billing database). SPECT/CT actually ensures a mean expenditure reduction of 98.7 <euro>/patient (95% CI: 47.96 <euro>-149.42 <euro>), diagnostic costs variation amounting to 11.2 <euro>/procedure.
  
  
  CONCLUSIONS
  SPECT/CT ensures better focus for the surgical exploration, shortens surgical times, and eventually cuts costs when used for localization of parathyroid adenomas.
authors.affiliation: Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy. giacomopata@alice.it
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
authors.forename: Claudio
authors.initials: C
authors.lastname: Casella
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Magri
authors.forename: Silvia
authors.initials: S
authors.lastname: Lucchini
authors.forename: Maria Beatrice
authors.initials: MB
authors.lastname: Panarotto
authors.forename: Nicola
authors.initials: N
authors.lastname: Crea
authors.forename: Raffaele
authors.initials: R
authors.lastname: Giubbini
authors.forename: Bruno
authors.initials: B
authors.lastname: Salerni
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000191:economics*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000191:economics*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi