Therapeutics evolving: Bringing the science of innovative treatments into our everyday world

Abstract

Background:

Newer, less invasive surgical approaches to the treatment of HPT (Unilateral Neck Exploration (UNE), Minimally Invasive Parathyroidectomy (MIP)) have become commonplace in recent years, however the cost- effectiveness of these strategies has been questioned, given the well-documented effectiven ess of the gold standard Bilateral Neck Exploration (BNE). The objective of our study was to determine the relative incremental cost- effectiveness of the BNE, UNE and MIP surgical techniques in treating patients with HPT.

Methods:

Resource utilization and outcome data was collected prospectively on patients presenting to St. Paul’s hospital for surgical treatment for HPT, 2002-2005. The primary measure of effectiveness was the rate of complications (hypocalcemia, paresthesias) post-surgery. Net Health Benefits were compared between the three treatment options (lambda=$15000). Non-parametric bootstrapping was applied to evaluate uncertainty around estimates of costs and effectiveness.

Results:

Patient-level data on a total of 94 patients (50=BNE, 19=UNE, 25=MIP) provided estimates of mean costs between treatment arms (BNE=$4843; SE=(944), UNE=$4881 (519), MIP=$5954 (842)) as well as estimate s of rates of complications (BNE=0.10, UNE=0.16, MIP=0.04). The gold standard BNE strategy displayed 1st-order stochastic dominance over the UNE strategy, and 2nd-order stochastic dominance over the MIP strategy (Incremental Net Health Benefits: UNE vs. BNE: -$723, 95% C.I. (-$3454, $1660); MIP vs. BNE: -$132 (-$1877, $1519)).

Conclusions:

Our results suggest that in the experience of HPT surgery at St. Paul’s Hospita l, newer, costlier strategies of treatment of HPT may be less cost-effective than the gold standard Bilateral Neck Exploration.