Journal article
Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy
British journal of surgery, Vol.104(11), pp.1523-1531
10/01/2017
DOI: 10.1002/bjs.10582
PMID: 28707698
Abstract
BackgroundIntraoperative nerve monitoring (IONM) provides dynamic neural information and is recommended for high-risk thyroid surgery. In this analysis, the cost-effectiveness of IONM in preventing bilateral recurrent laryngeal nerve (RLN) injury was investigated.
MethodsA Markov chain model was constructed based on IONM use. The base-case patient was defined as a 40-year-old woman presenting with a 41-cm left-sided papillary thyroid cancer who developed RLN injury with loss of monitoring signal during planned bilateral thyroidectomy. It was hypothesized that, if the surgeon had used IONM, the RLN injury would have been detected and the operation would have been concluded as a thyroid lobectomy to avoid the risk of contralateral RLN injury. Cost in US dollars was converted to euros; probabilities and utility scores were identified from the literature and government resources. Length of follow-up was set as 20 years, and willingness-to-pay (WTP) as Euro38 000 (US $50 000) per quality-adjusted life-year (QALY).
ResultsAt the end of year 20, the not using IONM strategy accrued Euro163 99540 (US $215 78343) and an effectiveness of 1415 QALYs, whereas use of the IONM strategy accrued Euro170 28368 (US $224 05748) and an effectiveness of 1433 QALYs. The incremental cost-effectiveness ratio, comparing use versus no use of IONM, was Euro35 28526 (US $46 42797) per QALY, which is below the proposed WTP, indicating that IONM is the preferred and cost-effective management plan. A Monte Carlo simulation test that considered variability of the main study factors in a hypothetical sample of 10 000 patients showed IONM to be the preferred strategy in 858 per cent of the population.
ConclusionUse of IONM is cost-effective in patients undergoing bilateral thyroid surgery.
Cost-effective in this scenario
Details
- Title: Subtitle
- Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy
- Creators
- Z. Al-Qurayshi - Univ Iowa Hosp & Clin, Dept Otolaryngol Head & Neck Surg, Iowa City, IA 52242 USAE. Kandil - Tulane UniversityG. W. Randolph - Massachusetts General Hospital
- Resource Type
- Journal article
- Publication Details
- British journal of surgery, Vol.104(11), pp.1523-1531
- Publisher
- Wiley
- DOI
- 10.1002/bjs.10582
- PMID
- 28707698
- ISSN
- 0007-1323
- eISSN
- 1365-2168
- Number of pages
- 9
- Language
- English
- Date published
- 10/01/2017
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984702822102771
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