COST-EFFECTIVENESS OF PARATHYROIDECTOMY FOR PRIMARY HYPERPARATHYROIDISM

Objective: To review cost-effectiveness analyses of treatments for primary hyperparathyroidism (PHPT). Methods: The PubMed database was searched with the keywords cost effectiveness and primary hyperparathyroidism. The results of all studies identified were reviewed to ensure that the cost-effectiveness data were reported using incremental cost-effectiveness ratios, which are critical metrics for formal cost-effectiveness analysis. Results: Six studies were identified that measured the cost-effectiveness of competing treatment strategies for PHPT with incremental cost-effectiveness ratios. Three studies were identified that compared surgical and medical treatment options for asymptomatic PHPT. Effectiveness was measured in quality-adjusted life years. In these studies, the strategy of medical observation was less effective than surgery. Surgery was less costly and more effective than pharmacologic therapy. Minimally invasive surgery was a cost-effective alternative to traditional surgical approaches. Parathyroidectomy was cost-effective for asymptomatic patients with a predicted life expectancy of 5 years (outpatient parathyroidectomy) or 6.5 years (inpatient parathyroidectomy). For patients with a shorter life expectancy, observation was the optimal strategy. One study examined the cost-effectiveness of 3 strategies for the surgical treatment of symptomatic PHPT. A minimally invasive treatment strategy had the lowest rate of surgical complications (5.3%), and when compared with bilateral neck exploration, produced an incremental cost effectiveness ratio of $28 439 per complication avoided. Two studies examined the cost effectiveness of adjunctive preoperative imaging in patients with PHPT. The results of both analyses favored preoperative imaging over immediate bilateral neck exploration. Conclusions: Parathyroidectomy has superior outcomes to observation, but it is more costly. Pharmacologic treatment strategies are quite costly, and offer limited benefits. The contemporary strategy of offering minimally invasive procedures with preoperative localization appears to be cost-effective.