Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients
BackgroundThere are three main surgical treatment options for secondary hyperparathyroidism (SHPT): subtotal parathyroidectomy (sPTX), total parathyroidectomy with auto-transplantation (tPTX+AT), and total parathyroidectomy (tPTX). However, a debate regarding which of these surgical methods is optim...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1495818/full |
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| author | Qila Sa Qila Sa Yinghui Zhou Guangming Cheng Boyuan Nan Yingnan Feng Yingnan Feng Ningyuan Zhang Ningyuan Zhang Wantao Xie Wantao Xie Wei Zhang |
| author_facet | Qila Sa Qila Sa Yinghui Zhou Guangming Cheng Boyuan Nan Yingnan Feng Yingnan Feng Ningyuan Zhang Ningyuan Zhang Wantao Xie Wantao Xie Wei Zhang |
| author_sort | Qila Sa |
| collection | DOAJ |
| description | BackgroundThere are three main surgical treatment options for secondary hyperparathyroidism (SHPT): subtotal parathyroidectomy (sPTX), total parathyroidectomy with auto-transplantation (tPTX+AT), and total parathyroidectomy (tPTX). However, a debate regarding which of these surgical methods is optimal has been ongoing. Aim of this study is to compare medical costs and final outcomes associated with the three surgical approaches for the entire treatment duration, aiming to identify the most cost-effective surgical method.MethodsBased on previous research data from domestic and international studies, as well as data from on-site surveys, TreeAge Pro 2022 software was used to construct a Markov model for the surgical treatment of SHPT patients. The model was run using data from the 2022 registered population of end-stage renal disease dialysis patients in China (1 million) as baseline cohort. Main indicators for this analysis are total cost, quality-adjusted life years, and incremental cost-effectiveness ratio (ICER). The study period is 10 years post-surgery, with a discount rate of 5% per year. Uncertainty in the model was assessed using one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).ResultsThe costs incurred by SHPT patients undergoing sPTX, tPTX, and tPTX+AT within 10 years post-surgery are $7042.54, $9983.00, and $11435.60, respectively, with total utilities generated being 13.23 QALYs, 18.76 QALYs, and 18.69 QALYs. Compared to sPTX, the incremental costs and incremental effects of tPTX and tPTX+AT are $2,924.71 and $4,456.66, with 5.53 QALYs and 5.46 QALYs, respectively. The ICER for tPTX and tPTX+AT groups are $532.13/QALY and $805.10/QALY, respectively, which are well below our set willingness-to-pay (WTP) threshold. Sensitivity analysis results indicate that varying any parameter within a certain range over the given time interval will not cause the ICER to exceed the WTP threshold and will not reverse the primary analysis results.ConclusionIn the Chinese healthcare system, tPTX is considered the most cost-effective treatment for refractory hyperparathyroidism, when compared to tPTX+AT and sPTX. |
| format | Article |
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| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-b00abe19317741f786ade2a4a47c66a32025-01-27T06:40:53ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-01-011510.3389/fendo.2024.14958181495818Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patientsQila Sa0Qila Sa1Yinghui Zhou2Guangming Cheng3Boyuan Nan4Yingnan Feng5Yingnan Feng6Ningyuan Zhang7Ningyuan Zhang8Wantao Xie9Wantao Xie10Wei Zhang11Department of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaDalian Medical University, General Hospital of Northern Theater Command Training Base for Graduate, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaDalian Medical University, General Hospital of Northern Theater Command Training Base for Graduate, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaChinese Medical University, General Hospital of Northern Theater Command Training Base for Graduate, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaChinese Medical University, General Hospital of Northern Theater Command Training Base for Graduate, Shenyang, ChinaDepartment of Hepatobiliary Pancreatic Splenic and Thyroid Surgery, General Hospital of Northern Theater Command, Shenyang, ChinaBackgroundThere are three main surgical treatment options for secondary hyperparathyroidism (SHPT): subtotal parathyroidectomy (sPTX), total parathyroidectomy with auto-transplantation (tPTX+AT), and total parathyroidectomy (tPTX). However, a debate regarding which of these surgical methods is optimal has been ongoing. Aim of this study is to compare medical costs and final outcomes associated with the three surgical approaches for the entire treatment duration, aiming to identify the most cost-effective surgical method.MethodsBased on previous research data from domestic and international studies, as well as data from on-site surveys, TreeAge Pro 2022 software was used to construct a Markov model for the surgical treatment of SHPT patients. The model was run using data from the 2022 registered population of end-stage renal disease dialysis patients in China (1 million) as baseline cohort. Main indicators for this analysis are total cost, quality-adjusted life years, and incremental cost-effectiveness ratio (ICER). The study period is 10 years post-surgery, with a discount rate of 5% per year. Uncertainty in the model was assessed using one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).ResultsThe costs incurred by SHPT patients undergoing sPTX, tPTX, and tPTX+AT within 10 years post-surgery are $7042.54, $9983.00, and $11435.60, respectively, with total utilities generated being 13.23 QALYs, 18.76 QALYs, and 18.69 QALYs. Compared to sPTX, the incremental costs and incremental effects of tPTX and tPTX+AT are $2,924.71 and $4,456.66, with 5.53 QALYs and 5.46 QALYs, respectively. The ICER for tPTX and tPTX+AT groups are $532.13/QALY and $805.10/QALY, respectively, which are well below our set willingness-to-pay (WTP) threshold. Sensitivity analysis results indicate that varying any parameter within a certain range over the given time interval will not cause the ICER to exceed the WTP threshold and will not reverse the primary analysis results.ConclusionIn the Chinese healthcare system, tPTX is considered the most cost-effective treatment for refractory hyperparathyroidism, when compared to tPTX+AT and sPTX.https://www.frontiersin.org/articles/10.3389/fendo.2024.1495818/fullsecondary hyperparathyroidismparathyroidectomycost-effectiveness analysisMarkov modelsurgical approaches |
| spellingShingle | Qila Sa Qila Sa Yinghui Zhou Guangming Cheng Boyuan Nan Yingnan Feng Yingnan Feng Ningyuan Zhang Ningyuan Zhang Wantao Xie Wantao Xie Wei Zhang Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients Frontiers in Endocrinology secondary hyperparathyroidism parathyroidectomy cost-effectiveness analysis Markov model surgical approaches |
| title | Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients |
| title_full | Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients |
| title_fullStr | Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients |
| title_full_unstemmed | Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients |
| title_short | Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients |
| title_sort | cost effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients |
| topic | secondary hyperparathyroidism parathyroidectomy cost-effectiveness analysis Markov model surgical approaches |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1495818/full |
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