title: Cost-benefit analysis of the intraoperative parathyroid hormone assay in primary hyperparathyroidism.
abstract: The purpose of this study was to evaluate the usefulness of the routine intraoperative intact parathyroid hormone (IOPTH) assay, the role of unilateral and bilateral cervical exploration and of preoperative imaging, and to do a cost-benefit analysis in parathyroidectomy for primary hyperparathyroidism.
  
  
  
  Two hundred sixty-four patients who underwent operations between January 2000 and March 2015 were retrospectively divided into 2 groups.
  
  
  
  Group A (IOPTH) was composed of 64 patients. Ultrasonography and technetium-99m-sestamibi (MIBI) identified the adenoma in 38 cases. Bilateral exploration was performed in 43 patients; of which 2 failures occurred. The IOPTH false-negative rate was 18.4%. The average cost was €1297.30. Group B (without IOPTH) was composed of 200 patients. Ultrasonography and MIBI identified the adenoma in 113 cases. Bilateral exploration was performed in 129 patients; of which 2 failures occurred. The average cost was €618.75.
  
  
  
  The IOPTH assay should be used only in few selected cases because of its high cost. The experience of the team is essential to obtain a high cure rate. © 2016 Wiley Periodicals, Inc. Head Neck 39: 241-246, 2017.
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Badii
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Staderini
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Foppa
authors.affiliation: Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Tofani
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Ileana
authors.initials: I
authors.lastname: Skalamera
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Fiorenza
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Qirici
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cianchi
authors.affiliation: Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Perigli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006785:Hospitals, University; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D007558:Italy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000191:economics* / Q000379:methods; D061646:Operative Time; D010281:Parathyroid Hormone / Q000032:analysis*; D016105:Parathyroidectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi
keywords: intraoperative parathyroid hormone (PTH) assay; intraoperative parathyroid hormone (PTH) cost analysis; minimally invasive parathyroid surgery; primary hyperparathyroidism