Cost-effectiveness in transient hypocalcemia post-thyroidectomy

Area of Science:

• Endocrinology
• Surgical Outcomes
• Health Economics

Background:

• Transient hypocalcemia is a common complication following total thyroidectomy.
• Effective management strategies are crucial for patient recovery and cost-efficiency.
• Assessing the reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) is key to managing this condition.

Purpose of the Study:

• To compare the cost-effectiveness of three distinct management strategies for transient hypocalcemia post-thyroidectomy.
• To evaluate the diagnostic accuracy and predictive value of TSCa, ICa, and iPTH in identifying and managing hypocalcemia.

Main Methods:

• A multicenter, prospective randomized study involving 169 patients.
• Comparison of three strategies:
• preventive
• (oral calcium + vitamin D)
• reactive
• (therapy upon hypocalcemia diagnosis)
• and
• predictive
• (therapy if iPTH <10 pg/mL).

Main Results:

• Total serum calcium (TSCa) demonstrated higher accuracy (84.6%) in identifying symptomatic hypocalcemia compared to ionized calcium (ICa) (50.0%).
• TSCa at 24 and 48 hours post-surgery identified 24.8% and an additional 10.6% of patients with hypocalcemia, respectively.
• Intact parathyroid hormone (iPTH) showed low sensitivity for predicting hypocalcemia. No significant differences in hospitalization or symptomatic cases were observed between groups, but costs varied significantly.

Conclusions:

• No strategy enabled early discharge without the risk of transient hypocalcemia.
• The
• preventive
• strategy, involving oral calcium and vitamin D, was found to be the most cost-effective approach, despite leading to overtreatment.