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Third Canadian Therapeutics Congress


Cost-effectiveness analysis, surgery, primary hyperparathyroidism



Newer, less invasive surgical approaches to the treatment of HPT (Unilateral Neck Exploration (UNE), Minimally Invasive Parathyroidectomy (MIP)) have become commonplace in recent years, however the cost- effectiveness of these strategies has been questioned, given the well-documented effectiven ess of the gold standard Bilateral Neck Exploration (BNE). The objective of our study was to determine the relative incremental cost- effectiveness of the BNE, UNE and MIP surgical techniques in treating patients with HPT.


Resource utilization and outcome data was collected prospectively on patients presenting to St. Paul’s hospital for surgical treatment for HPT, 2002-2005. The primary measure of effectiveness was the rate of complications (hypocalcemia, paresthesias) post-surgery. Net Health Benefits were compared between the three treatment options (lambda=$15000). Non-parametric bootstrapping was applied to evaluate uncertainty around estimates of costs and effectiveness.


Patient-level data on a total of 94 patients (50=BNE, 19=UNE, 25=MIP) provided estimates of mean costs between treatment arms (BNE=$4843; SE=(944), UNE=$4881 (519), MIP=$5954 (842)) as well as estimate s of rates of complications (BNE=0.10, UNE=0.16, MIP=0.04). The gold standard BNE strategy displayed 1st-order stochastic dominance over the UNE strategy, and 2nd-order stochastic dominance over the MIP strategy (Incremental Net Health Benefits: UNE vs. BNE: -$723, 95% C.I. (-$3454, $1660); MIP vs. BNE: -$132 (-$1877, $1519)).


Our results suggest that in the experience of HPT surgery at St. Paul’s Hospita l, newer, costlier strategies of treatment of HPT may be less cost-effective than the gold standard Bilateral Neck Exploration.

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