Would scan, but which scan? A cost-utility analysis to optimize preoperative imaging for primary hyperparathyroidism. Surgery 2011 Dec;150(6):1286-94
Date
12/06/2011Pubmed ID
22136852DOI
10.1016/j.surg.2011.09.016Scopus ID
2-s2.0-82755195137 (requires institutional sign-in at Scopus site) 74 CitationsAbstract
BACKGROUND: Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative localization. This study examines the cost-utility of sestamibi in combination with single photon emission computed tomography (sestamibi-SPECT); ultrasound; and 4-dimensional computed tomography (4D-CT).
METHODS: A decision tree was constructed for patients undergoing initial parathyroidectomy. Patients were randomized to 1 of 5 preoperative localization protocols: (1) ultrasound; (2) sestamibi-SPECT; (3) 4D-CT; (4) sestamibi-SPECT and ultrasound; and (5) sestamibi-SPECT and ultrasound and 4D-CT, if discordant (sestamibi-SPECT and ultrasound ± 4D-CT). From a societal perspective, all relevant costs were included. Input data were obtained from literature and Medicare. The incremental cost-utility ratio was determined in dollars per quality-adjusted life years ($/QALY). Sensitivity analyses were performed.
RESULTS: In the base-case, ultrasound was least expensive, with a cost of $6666, compared to $6773 (4-D CT); $7214 (sestamibi-SPECT and ultrasound ± 4D-CT); $7330 (sestamibi-SPECT); and $7371(sestamibi-SPECT and ultrasound). Sestamibi-SPECT and ultrasound ± 4D-CT were most cost-effective because improved localization resulted in fewer bilateral explorations. QALY were comparable across modalities. Compared to sestamibi-SPECT, ultrasound, 4D- CT, and sestamibi-SPECT and ultrasound ± 4D-CT resulted a win-win situation-costing less and accruing more utility. Sensitivity analyses demonstrated that the model was sensitive to surgery cost and diagnostic accuracy of imaging.
CONCLUSION: In our model, sestamibi-SPECT and ultrasound ± 4D-CT were the most cost-effective methods, followed by 4D-CT and ultrasound. Sestamibi-SPECT alone was least cost-effective. Cost-utilities were dependent on the sensitivities of ultrasound and 4D-CT and may vary by institution.
Author List
Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JAAuthor
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AlgorithmsCost-Benefit Analysis
Decision Trees
Four-Dimensional Computed Tomography
Health Care Costs
Humans
Hyperparathyroidism, Primary
Models, Economic
Parathyroidectomy
Preoperative Care
Quality-Adjusted Life Years
Radiopharmaceuticals
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon
Ultrasonography
United States
