Cost-effectiveness of scan-directed parathyroidectomy

Langenbecks Arch Surg. 2008 Sep;393(5):739-43. doi: 10.1007/s00423-008-0383-6. Epub 2008 Aug 1.


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.

MeSH terms

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


  • Parathyroid Hormone
  • Technetium Tc 99m Sestamibi