title: Comparison of single photon emission CT (SPECT) with SPECT/CT imaging in preoperative localization of parathyroid adenomas: A cost-effectiveness analysis.
abstract: Controversy exists regarding the superiority of single photon emission CT (SPECT)/CT over SPECT for preoperative localization of parathyroid adenomas in primary hyperparathyroidism (PHPT), as well as the cost-effectiveness.
  
  
  
  A retrospective review was undertaken of patients undergoing surgery for PHPT from January 2009 to August 2014. Ultrasound and SPECT (ultrasound-SPECT) or SPECT/CT (ultrasound-SPECT/CT) were performed for each patient. Sensitivity and positive predictive value (PPV) of each modality were calculated. Cost-effectiveness was determined by an incremental cost-effectiveness ratio (ICER) analysis.
  
  
  
  Two hundred fifty-nine patients with 266 parathyroid adenomas were included in the study. Lateralization sensitivity and PPV of ultrasound-SPECT were 85.1% and 98.2%, respectively. The lateralization sensitivity and PPV of ultrasound-SPECT/CT were 86.9% and 99.4%, respectively. A cost of $2499.22 (CAD) per additional parathyroid adenoma detection by ultrasound-SPECT/CT was determined from the ICER analysis.
  
  
  
  Similar sensitivities and PPVs were observed between ultrasound-SPECT and ultrasound-SPECT/CT in preoperatively lateralizing parathyroid adenomas, with relatively equivalent cost-effectiveness. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2062-E2065, 2016.
authors: Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: Brittany
authors: B
authors: Barber
authors: Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Conrad
authors: C
authors: Moher
authors: Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: David
authors: D
authors: Côté
authors: Department of Otolaryngology, Queen's University, Kingston, Ontario, Canada.
authors: Elaine
authors: E
authors: Fung
authors: Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: Daniel
authors: D
authors: O'Connell
authors: Division of Head and Neck Oncologic Surgery, University of Florida, Gainesville, Florida.
authors: Peter
authors: P
authors: Dziegielewski
authors: Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: Jeffrey
authors: J
authors: Harris
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000191:economics; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: adenoma; localization; parathyroid; sestamibi; single photon emission CT (SPECT/CT)