Which Localizing Strategy is the Most Cost-Effective in Reoperative Primary Hyperparathyroidism?

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Persistent or recurrent primary hyperparathyroidism (PHPT) affects 2%-10% of patients post-parathyroidectomy.
• Accurate preoperative localization is crucial for successful reoperative surgery.

Purpose of the Study:

• To determine the most cost-effective preoperative localization method for reoperative PHPT.
• To compare the cost-effectiveness of various imaging modalities and biopsy techniques.

Main Methods:

• Clinical decision analytic models were developed using TreeAge Pro.
• Probabilistic Sensitivity Analysis (PSA) was employed to assess model robustness.

Main Results:

• Ultrasound (US)-guided fine-needle aspiration (FNA) with PTH assay was the most cost-effective confirmatory test following initial US localization.
• Four-dimensional computed tomography (4D-CT) emerged as the most cost-effective strategy after a negative US localization.
• PSA confirmed the cost-effectiveness of US-guided FNA with PTH and 4D-CT in specific scenarios.

Conclusions:

• US-guided FNA with PTH assay is the preferred cost-effective method for confirming localization in reoperative PHPT after initial US.
• 4D-CT represents the next most cost-effective imaging choice when US localization is unsuccessful.