Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy: what about the costs?
BACKGROUND
The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification.


METHODS
Through a micro-costing approach, the thyroidectomy patient-care process (with and without IONM) was analyzed by considering direct costs (staff time, consumables, equipment, drugs, operating room, and general expenses). Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro-scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high-volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low-volume setting (1 procedure per week). Energy-based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about €2,600.


RESULTS
Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: €3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from €3,713 to €3,770 (scenarios 2 and 3), 5–7% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (€3,969).


CONCLUSIONS
The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5–7% of the hospitalization costs for a thyroidectomy.
Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria Varese-Como, Via Guicciardini, 21100 Varese, Italy. gianlorenzo.dionigi@uninsubria.it
Gianlorenzo
G
Dionigi
Alessandro
A
Bacuzzi
Luigi
L
Boni
Stefano
S
Rausei
Francesca
F
Rovera
Renzo
R
Dionigi
D017721:Hospital Costs; D006801:Humans; D016343:Monitoring, Intraoperative / Q000191:economics* / Q000379:methods; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*