Cost-effectiveness in transient hypocalcemia post-thyroidectomy

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
JournalHead and Neck
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Hypocalcemia
Thyroidectomy
Cost-Benefit Analysis
Calcium
Parathyroid Hormone
Serum
Costs and Cost Analysis
Patient Discharge
Vitamin D
Hospitalization
Prospective Studies
Therapeutics

Keywords

  • cost
  • effectiveness
  • hypocalcemia
  • thyroidectomy
  • transient

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{39a979cc5ef048c6bad8e99770bc062a,
title = "Cost-effectiveness in transient hypocalcemia post-thyroidectomy",
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.",
keywords = "cost, effectiveness, hypocalcemia, thyroidectomy, transient",
author = "Giuseppe Mercante and Andrea Anelli and Diana Giannarelli and Davide Giordano and Ilenia Sinopoli and Fabio Ferreli and Giovanna Digiesi and Appetecchia, {Maria L.} and Agnese Barnabei and Giovanni Cristalli and Laura Conti and Raul Pellini and Piazza Fabio and Davide Lombardi and {De Virgilio}, Armando and Giuseppe Spriano",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/hed.25934",
language = "English",
journal = "Head and Neck Surgery",
issn = "1043-3074",
publisher = "Wiley-Liss Inc.",

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TY - JOUR

T1 - Cost-effectiveness in transient hypocalcemia post-thyroidectomy

AU - Mercante, Giuseppe

AU - Anelli, Andrea

AU - Giannarelli, Diana

AU - Giordano, Davide

AU - Sinopoli, Ilenia

AU - Ferreli, Fabio

AU - Digiesi, Giovanna

AU - Appetecchia, Maria L.

AU - Barnabei, Agnese

AU - Cristalli, Giovanni

AU - Conti, Laura

AU - Pellini, Raul

AU - Fabio, Piazza

AU - Lombardi, Davide

AU - De Virgilio, Armando

AU - Spriano, Giuseppe

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - cost

KW - effectiveness

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KW - thyroidectomy

KW - transient

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