title: Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy.
abstract: BACKGROUND
  Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy.
  
  
  OBJECTIVE
  To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country.
  
  
  METHODS
  We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis.
  
  
  RESULTS
  We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065.
  
  
  CONCLUSIONS
  Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.
authors: Unidad de Oncología, Hospital Pablo Tobón Uribe, Medellín, Colombia.
authors: Álvaro
authors: Á
authors: Sanabria
authors: Departamento de Cirugía, Universidad Surcolombiana, Neiva, Colombia.
authors: Adonis
authors: A
authors: Ramírez
mesh_terms: D003105:Colombia; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003906:Developing Countries; D004558:Electric Stimulation / Q000295:instrumentation; D004576:Electromyography / Q000191:economics / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D064795:Intraoperative Neurophysiological Monitoring / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D007442:Intubation, Intratracheal / Q000295:instrumentation; D007902:Length of Stay / Q000191:economics; D015201:Meta-Analysis as Topic; D011336:Probability; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics*; D014139:Tracheostomy / Q000191:economics; D019564:Unnecessary Procedures / Q000191:economics