Cost-effectiveness in transient hypocalcemia post-thyroidectomy

Giuseppe Mercante, Andrea Anelli, Diana Giannarelli, Davide Giordano, Ilenia Sinopoli, Fabio Ferreli, Giovanna Digiesi, Maria L. Appetecchia, Agnese Barnabei, Giovanni Cristalli, Laura Conti, Raul Pellini, Piazza Fabio, Davide Lombardi, Armando De Virgilio, Giuseppe Spriano

Research output: Contribution to journalArticle

Abstract

Background: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. Methods: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were “preventive” (oral calcium + vitamin D supplementation), “reactive” (therapy in hypocalcemia), and “predictive” (therapy if iPTH <10 pg/mL). Results: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the “reactive” and “predictive” groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. Conclusions: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The “preventive” strategy was the most cost-effective, despite overtreatment.

Original languageEnglish
Pages (from-to)3940-3947
Number of pages8
JournalHead and Neck
Volume41
Issue number11
DOIs
Publication statusPublished - Nov 1 2019

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Keywords

  • cost
  • effectiveness
  • hypocalcemia
  • thyroidectomy
  • transient

ASJC Scopus subject areas

  • Otorhinolaryngology

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