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BACKGROUND: Concordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT). AIM: To investigate the financial implications of scan-directed parathyroid surgery. METHODS: Analysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre. RESULTS: Two hundred patients (138F:62M, age 18-91years) were operated for non-familial PHPT between Jan 2003 and Oct 2007. MIP was performed in 129 patients, with a mean operative time was 35 +/- 18min. Some 75 patients were discharged the same day and the others had a total of 72 in-patient days. Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58 +/- 25min. Only nine patients were discharged the same day and a total of 93 in-patient days were used ( approximately 1.3days/patient). The estimated total costs incurred were pound215,035 ( approximately 290,000<euro>). These costs would have been covered by the National Tariff ( pound2,170 per parathyroidectomy) but were higher than those possibly incurred if all 200 patients would have undergone BNE without any radiological investigations ( pound166,000 approximately 224,100euro). CONCLUSION: Shorter operative time and day-case admission for MIP generate costs savings that compensate only partially for the additional costs associated with parathyroid imaging studies.

Original publication

DOI

10.1007/s00423-008-0383-6

Type

Journal article

Journal

Langenbecks Arch Surg

Publication Date

09/2008

Volume

393

Pages

739 - 743

Keywords

Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Cost-Benefit Analysis, Female, Hospital Costs, Humans, Hyperparathyroidism, Primary, Length of Stay, Male, Middle Aged, Minimally Invasive Surgical Procedures, National Health Programs, Neoplasms, Multiple Primary, Parathyroid Hormone, Parathyroid Neoplasms, Parathyroidectomy, Radionuclide Imaging, Sensitivity and Specificity, Technetium Tc 99m Sestamibi, Ultrasonography, Young Adult