1. A cost-utility analysis of 18F-fluorocholine-positron emission tomography imaging for localizing primary hyperparathyroidism in the United States.
- Author
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Yap A, Hope TA, Graves CE, Kluijfhout W, Shen WT, Gosnell JE, Sosa JA, Roman SA, Duh QY, and Suh I
- Subjects
- Choline administration & dosage, Choline analogs & derivatives, Choline economics, Fluorine Radioisotopes administration & dosage, Fluorine Radioisotopes economics, Four-Dimensional Computed Tomography economics, Humans, Hyperparathyroidism, Primary economics, Hyperparathyroidism, Primary etiology, Hyperparathyroidism, Primary surgery, Medicare economics, Medicare statistics & numerical data, Models, Economic, Parathyroid Glands pathology, Parathyroid Glands surgery, Parathyroid Neoplasms complications, Parathyroid Neoplasms economics, Parathyroid Neoplasms surgery, Parathyroidectomy, Positron Emission Tomography Computed Tomography economics, Positron-Emission Tomography methods, Preoperative Care economics, Preoperative Care methods, Quality-Adjusted Life Years, Radiopharmaceuticals administration & dosage, Radiopharmaceuticals economics, Sensitivity and Specificity, Technetium Tc 99m Sestamibi administration & dosage, Technetium Tc 99m Sestamibi economics, Ultrasonography economics, United States, Cost-Benefit Analysis statistics & numerical data, Hyperparathyroidism, Primary diagnosis, Parathyroid Glands diagnostic imaging, Parathyroid Neoplasms diagnosis, Positron-Emission Tomography economics
- Abstract
Background: Primary hyperparathyroidism historically necessitated bilateral neck exploration to remove abnormal parathyroid tissue. Improved localization allows for focused parathyroidectomy with lower complication risks. Recently, positron emission tomography using radiolabeled 18F-fluorocholine demonstrated high accuracy in detecting these lesions, but its cost-effectiveness has not been studied in the United States., Methods: A decision tree modeled patients who underwent parathyroidectomy for primary hyperparathyroidism using single preoperative localization modalities: (1) positron emission tomography using radiolabeled 18F-fluorocholine, (2) 4-dimensional computed tomography, (3) ultrasound, and (4) sestamibi single photon emission computed tomography (SPECT). All patients underwent either focused parathyroidectomy versus bilateral neck exploration, with associated cost ($) and clinical outcomes measured in quality-adjusted life-years gained. Model parameters were informed by literature review and Medicare costs. Incremental cost-utility ratios were calculated in US dollars/quality-adjusted life-years gained, with a willingness-to-pay threshold set at $100,000/quality-adjusted life-year. One-way, 2-way, and threshold sensitivity analyses were performed., Results: Positron emission tomography using radiolabeled 18F-fluorocholine gained the most quality-adjusted life-years (23.9) and was the costliest ($2,096), with a total treatment cost of $11,245 or $470/quality-adjusted life-year gained. Sestamibi single photon emission computed tomography and ultrasound were dominated strategies. Compared with 4-dimentional computed tomography, the incremental cost-utility ratio for positron emission tomography using radiolabeled 18F-fluorocholine was $91,066/quality-adjusted life-year gained in our base case analysis, which was below the willingness-to-pay threshold. In 1-way sensitivity analysis, the incremental cost-utility ratio was sensitive to test accuracy, positron emission tomography using radiolabeled 18F-fluorocholine price, postoperative complication probabilities, proportion of bilateral neck exploration patients needing overnight hospitalization, and life expectancy., Conclusion: Our model elucidates scenarios in which positron emission tomography using radiolabeled 18F-fluorocholine can potentially be a cost-effective imaging option for primary hyperparathyroidism in the United States. Further investigation is needed to determine the maximal cost-effectiveness for positron emission tomography using radiolabeled 18F-fluorocholine in selected populations., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
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