A comparative cost-utility analysis of postoperative calcium supplementation strategies used in the current management of hypocalcemia

Surgery. 2020 Jan;167(1):137-143. doi: 10.1016/j.surg.2019.05.077. Epub 2019 Sep 10.


Background: Symptomatic hypocalcemia is a common complication of total thyroidectomy. Management strategies include responsive treatment initiation for symptoms or prevention by routine or parathyroid hormone-directed calcium supplementation. The comparative cost-effectiveness of even the most often utilized strategies is unclear.

Methods: A Markov cohort model was created to compare routine supplementation with calcium alone (RS), postoperative parathyroid hormone-based selective supplementation with calcium and calcitriol (SS), and no supplementation (NS) in asymptomatic patients. Patients could remain asymptomatic or develop symptomatic hypocalcemia, managed with outpatient oral supplementation or intravenous calcium infusion and administered either inpatient or outpatient. Effectiveness was measured in quality-adjusted life years. Sensitivity analyses were performed to test model parameter assumptions.

Results: RS was the preferred strategy, costing $329/patient and resulting in 0.497 quality-adjusted life years, which was only marginally better compared to SS ($373 for 0.495 quality-adjusted life years). NS was most costly at $4,955 for 0.491 quality-adjusted life years. Preference for RS over SS was sensitive to the probability of developing symptoms and the probability of symptom treatment with intravenous supplementation. On probabilistic sensitivity analysis, RS was preferred in 75.4% of scenarios.

Conclusion: After total thyroidectomy, a preventative calcium supplementation strategy should be strongly considered. In this data-driven theoretical model, RS was the least costly option and resulted in an incremental gain in quality-adjusted life years.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Calcitriol / administration & dosage
  • Calcitriol / economics
  • Calcium / administration & dosage
  • Calcium / economics
  • Computer Simulation
  • Cost-Benefit Analysis*
  • Dietary Supplements / economics*
  • Drug Costs / statistics & numerical data
  • Humans
  • Hypocalcemia / drug therapy
  • Hypocalcemia / economics*
  • Hypocalcemia / etiology
  • Hypocalcemia / prevention & control
  • Markov Chains
  • Models, Economic
  • Parathyroid Hormone / blood
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / economics
  • Postoperative Complications / etiology
  • Quality-Adjusted Life Years
  • Thyroidectomy / adverse effects*


  • Parathyroid Hormone
  • Calcitriol
  • Calcium