Cost-effectiveness of parathyroidectomy for primary hyperparathyroidism

Area of Science:

• Endocrinology
• Health Economics
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
• Treatment options for PHPT include surgery, medical observation, and pharmacologic therapy.
• Evaluating the cost-effectiveness of different PHPT treatments is crucial for resource allocation.

Purpose of the Study:

• To review and synthesize the findings of cost-effectiveness analyses (CEAs) for primary hyperparathyroidism treatments.
• To compare the economic value of surgical versus non-surgical interventions for PHPT.

Main Methods:

• A systematic search of the PubMed database was conducted using keywords 'cost effectiveness' and 'primary hyperparathyroidism'.
• Studies reporting incremental cost-effectiveness ratios (ICERs) were selected for review.
• Effectiveness was primarily measured in quality-adjusted life years (QALYs).

Main Results:

• Surgery was found to be more effective and less costly than pharmacologic therapy for PHPT.
• Minimally invasive parathyroidectomy was a cost-effective alternative to traditional surgical approaches.
• Parathyroidectomy was cost-effective for asymptomatic patients with a life expectancy of 5-6.5 years; observation was optimal for shorter life expectancies.
• Minimally invasive surgery for symptomatic PHPT yielded an ICER of $28,439 per complication avoided compared to bilateral neck exploration.
• Preoperative imaging was favored over immediate bilateral neck exploration for cost-effectiveness.

Conclusions:

• Parathyroidectomy offers superior outcomes to observation but at a higher initial cost.
• Pharmacologic treatments for PHPT are expensive with limited benefits.
• Current strategies involving minimally invasive procedures and preoperative localization appear to be the most cost-effective approach for PHPT management.