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Erschienen in:
01.09.2008 | Original Article
Cost-effectiveness of scan-directed parathyroidectomy
Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 5/2008
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Background
Concordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT).
Aim
To investigate the financial implications of scan-directed parathyroid surgery.
Methods
Analysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre.
Results
Two hundred patients (138F:62M, age 18–91years) were operated for non-familial PHPT between Jan 2003 and Oct 2007. MIP was performed in 129 patients, with a mean operative time was 35 ± 18min. Some 75 patients were discharged the same day and the others had a total of 72 in-patient days. Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58 ± 25min. Only nine patients were discharged the same day and a total of 93 in-patient days were used (≈1.3days/patient). The estimated total costs incurred were £215,035 (≈290,000€). These costs would have been covered by the National Tariff (£2,170 per parathyroidectomy) but were higher than those possibly incurred if all 200 patients would have undergone BNE without any radiological investigations (£166,000 ≈ 224,100€).
Conclusion
Shorter operative time and day-case admission for MIP generate costs savings that compensate only partially for the additional costs associated with parathyroid imaging studies.