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Intraoperative quick parathyroid hormone versus same-day parathyroid hormone testing for minimally invasive
G Agarwal1, M S Barakate, B Robinson
1Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
Background:
Intraoperative quick parathyroid hormone (QPTH) measurement is claimed to eliminate failures during minimally invasive parathyroidectomy. The cost-effectiveness of QPTH (ie, true cost of avoiding a failed operation) needs careful evaluation.
Methods:
In 92 consecutive patients who underwent minimally invasive parathyroidectomy via a small lateral incision, QPTH was estimated preoperatively and at 5, 10, and 15 minutes postparathyroidectomy. QPTH results were subsequently compared with the procedure outcome. Cost-effectiveness analysis was performed for 3 subsequent theoretical management strategies: QPTH not performed, QPTH results available intraoperatively, and parathyroid hormone and serum calcium levels measured routinely with results made available the same day.
Results:
With criteria for cure being a decrease in the QPTH measurement to less than 50% of preoperative levels and to within normal range, QPTH predictions were true positive in 78 patients; false-negative in 7; false-positive in 1; and true negative in 2. The true cost of using QPTH measurement to avoid a failed operation was 19,801.19 US dollars, with 7 patients undergoing unnecessary conversion. Routine same-day parathyroid hormone and calcium measurements significantly reduced this to 624.73 dollars. Sensitivity analysis with varying cost assumptions demonstrated cost-effectiveness analysis to be robust.
Conclusions:
The fact that 97% of patients will be cured regardless of QPTH testing combined with its false-negative rates significantly reduces the cost-effectiveness of the test when compared with same-day parathyroid hormone testing.