Cost-effectiveness of parathyroidectomy for primary hyperparathyroidism.

Kyle Zanocco*, Michael Heller, Cord Sturgeon

*Corresponding author for this work

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

To review cost-effectiveness analyses of treatments for primary hyperparathyroidism (PHPT). The PubMed database was searched with the keywords "cost effectiveness" and "primary hyperparathyroidism." The results of all studies identified were reviewed to ensure that the cost-effectiveness data were reported using incremental cost-effectiveness ratios, which are critical metrics for formal cost-effectiveness analysis. Six studies were identified that measured the cost-effectiveness of competing treatment strategies for PHPT with incremental cost-effectiveness ratios. Three studies were identified that compared surgical and medical treatment options for asymptomatic PHPT. Effectiveness was measured in quality-adjusted life years. In these studies, the strategy of medical observation was less effective than surgery. Surgery was less costly and more effective than pharmacologic therapy. Minimally invasive surgery was a cost-effective alternative to traditional surgical approaches. Parathyroidectomy was cost-effective for asymptomatic patients with a predicted life expectancy of 5 years (outpatient parathyroidectomy) or 6.5 years (inpatient parathyroidectomy). For patients with a shorter life expectancy, observation was the optimal strategy. One study examined the cost-effectiveness of 3 strategies for the surgical treatment of symptomatic PHPT. A minimally invasive treatment strategy had the lowest rate of surgical complications (5.3%), and when compared with bilateral neck exploration, produced an incremental cost effectiveness ratio of $28,439 per complication avoided. Two studies examined the cost effectiveness of adjunctive preoperative imaging in patients with PHPT. The results of both analyses favored preoperative imaging over immediate bilateral neck exploration. Parathyroidectomy has superior outcomes to observation, but it is more costly. Pharmacologic treatment strategies are quite costly, and offer limited benefits. The contemporary strategy of offering minimally invasive procedures with preoperative localization appears to be cost-effective.

Original languageEnglish (US)
Pages (from-to)69-74
Number of pages6
JournalEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
Volume17 Suppl 1
DOIs
StatePublished - Mar 1 2011

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Parathyroidectomy
Primary Hyperparathyroidism
Cost-Benefit Analysis
Observation
Life Expectancy
Costs and Cost Analysis
Therapeutics
Neck
Preoperative Care
Minimally Invasive Surgical Procedures
Quality-Adjusted Life Years
PubMed
Inpatients
Outpatients
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Cost-effectiveness of parathyroidectomy for primary hyperparathyroidism.",
abstract = "To review cost-effectiveness analyses of treatments for primary hyperparathyroidism (PHPT). The PubMed database was searched with the keywords {"}cost effectiveness{"} and {"}primary hyperparathyroidism.{"} The results of all studies identified were reviewed to ensure that the cost-effectiveness data were reported using incremental cost-effectiveness ratios, which are critical metrics for formal cost-effectiveness analysis. Six studies were identified that measured the cost-effectiveness of competing treatment strategies for PHPT with incremental cost-effectiveness ratios. Three studies were identified that compared surgical and medical treatment options for asymptomatic PHPT. Effectiveness was measured in quality-adjusted life years. In these studies, the strategy of medical observation was less effective than surgery. Surgery was less costly and more effective than pharmacologic therapy. Minimally invasive surgery was a cost-effective alternative to traditional surgical approaches. Parathyroidectomy was cost-effective for asymptomatic patients with a predicted life expectancy of 5 years (outpatient parathyroidectomy) or 6.5 years (inpatient parathyroidectomy). For patients with a shorter life expectancy, observation was the optimal strategy. One study examined the cost-effectiveness of 3 strategies for the surgical treatment of symptomatic PHPT. A minimally invasive treatment strategy had the lowest rate of surgical complications (5.3{\%}), and when compared with bilateral neck exploration, produced an incremental cost effectiveness ratio of $28,439 per complication avoided. Two studies examined the cost effectiveness of adjunctive preoperative imaging in patients with PHPT. The results of both analyses favored preoperative imaging over immediate bilateral neck exploration. Parathyroidectomy has superior outcomes to observation, but it is more costly. Pharmacologic treatment strategies are quite costly, and offer limited benefits. The contemporary strategy of offering minimally invasive procedures with preoperative localization appears to be cost-effective.",
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N2 - To review cost-effectiveness analyses of treatments for primary hyperparathyroidism (PHPT). The PubMed database was searched with the keywords "cost effectiveness" and "primary hyperparathyroidism." The results of all studies identified were reviewed to ensure that the cost-effectiveness data were reported using incremental cost-effectiveness ratios, which are critical metrics for formal cost-effectiveness analysis. Six studies were identified that measured the cost-effectiveness of competing treatment strategies for PHPT with incremental cost-effectiveness ratios. Three studies were identified that compared surgical and medical treatment options for asymptomatic PHPT. Effectiveness was measured in quality-adjusted life years. In these studies, the strategy of medical observation was less effective than surgery. Surgery was less costly and more effective than pharmacologic therapy. Minimally invasive surgery was a cost-effective alternative to traditional surgical approaches. Parathyroidectomy was cost-effective for asymptomatic patients with a predicted life expectancy of 5 years (outpatient parathyroidectomy) or 6.5 years (inpatient parathyroidectomy). For patients with a shorter life expectancy, observation was the optimal strategy. One study examined the cost-effectiveness of 3 strategies for the surgical treatment of symptomatic PHPT. A minimally invasive treatment strategy had the lowest rate of surgical complications (5.3%), and when compared with bilateral neck exploration, produced an incremental cost effectiveness ratio of $28,439 per complication avoided. Two studies examined the cost effectiveness of adjunctive preoperative imaging in patients with PHPT. The results of both analyses favored preoperative imaging over immediate bilateral neck exploration. Parathyroidectomy has superior outcomes to observation, but it is more costly. Pharmacologic treatment strategies are quite costly, and offer limited benefits. The contemporary strategy of offering minimally invasive procedures with preoperative localization appears to be cost-effective.

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