Cost-Benefit Analysis of Intraoperative Autofluorescence for Parathyroid Identification

Area of Science:

• Endocrinology and Surgical Oncology
• Health Economics
• Medical Technology Assessment

Background:

• Hypoparathyroidism (hypoPT) is a common complication after total thyroidectomy, increasing morbidity and mortality.
• Conventional prevention relies on visual inspection of parathyroid glands.
• Near-infrared autofluorescence systems offer adjunct detection but involve significant costs.

Purpose of the Study:

• To evaluate the cost-effectiveness of autofluorescence for preventing hypoPT.
• To determine the chronic hypoPT rate at which autofluorescence becomes economically feasible.

Main Methods:

• A decision tree economic model compared autofluorescence-guided surgery with visual inspection alone.
• Costs included surgery, autofluorescence, and hypoPT management.
• Morbidity was assessed using quality-adjusted life-years (QALYs) over a lifetime horizon.
• Analysis focused on the Australian healthcare setting, quantifying costs in AUD (2024).

Main Results:

• Autofluorescence incurred an additional cost of A$1024 per surgery, yielding an incremental cost-effectiveness ratio (ICER) of A$128,234.
• The technology achieved cost-effectiveness at a chronic hypoPT rate of ≥5%.
• Cost-effectiveness was most sensitive to hypoPT rates and autofluorescence efficacy.

Conclusions:

• Autofluorescence involves higher upfront costs but can be cost-effective for hypoPT prevention.
• Economic feasibility hinges on the underlying chronic hypoPT rate and autofluorescence's effectiveness.
• Findings aid in prioritizing healthcare resource allocation for thyroidectomy procedures.