Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy
Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy
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DOI：
10.1002/bjs.10582
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发表时间：
2017-10-01
影响因子：
9.6
通讯作者：
Randolph, G. W.
中科院分区：
文献类型：
--
作者：
Al-Qurayshi, Z.;Kandil, E.;Randolph, G. W.
背景术中神经监测（IONM）提供动态神经信息，推荐用于高危甲状腺手术。在这项分析中，IONM在预防双侧喉返神经（RLN）injuries.MethodsA马尔可夫链模型的成本效益IONM使用的基础上构建。基础病例患者定义为一名40岁女性，患有41 cm左侧甲状腺乳头状癌，在计划的双侧甲状腺切除术期间发生喉返神经损伤伴监测信号丢失。假设，如果外科医生使用IONM，喉返神经损伤将被检测到，手术将被确定为甲状腺叶切除术，以避免对侧喉返神经损伤的风险。将美元成本转换为欧元;从文献和政府资源中确定概率和效用评分。随访时间定为20年，支付意愿定为38 000欧元结果在第20年末，未使用IONM策略的费用累计为16399540欧元（215 78343美元）和1，415个季度的效益，而使用综合网络管理处战略则产生了170 28368欧元（224 05748美元）和1，433个季度的效益。使用与不使用综合业务网的增量成本效益比为每质量调整生命年35 28526欧元（46 42797美元），低于拟议的支付意愿，表明综合业务网是首选和成本效益高的管理计划。一项Monte Carlo模拟试验考虑了10 000例患者的假设样本中主要研究因素的可变性，结果显示IONM是858%人群的首选策略。结论在接受双侧甲状腺手术的患者中使用IONM具有成本效益。
BackgroundIntraoperative nerve monitoring (IONM) provides dynamic neural information and is recommended for high-risk thyroid surgery. In this analysis, the cost-effectiveness of IONM in preventing bilateral recurrent laryngeal nerve (RLN) injury was investigated.MethodsA Markov chain model was constructed based on IONM use. The base-case patient was defined as a 40-year-old woman presenting with a 41-cm left-sided papillary thyroid cancer who developed RLN injury with loss of monitoring signal during planned bilateral thyroidectomy. It was hypothesized that, if the surgeon had used IONM, the RLN injury would have been detected and the operation would have been concluded as a thyroid lobectomy to avoid the risk of contralateral RLN injury. Cost in US dollars was converted to euros; probabilities and utility scores were identified from the literature and government resources. Length of follow-up was set as 20 years, and willingness-to-pay (WTP) as Euro38 000 (US $50 000) per quality-adjusted life-year (QALY).ResultsAt the end of year 20, the not using IONM strategy accrued Euro163 99540 (US $215 78343) and an effectiveness of 1415 QALYs, whereas use of the IONM strategy accrued Euro170 28368 (US $224 05748) and an effectiveness of 1433 QALYs. The incremental cost-effectiveness ratio, comparing use versus no use of IONM, was Euro35 28526 (US $46 42797) per QALY, which is below the proposed WTP, indicating that IONM is the preferred and cost-effective management plan. A Monte Carlo simulation test that considered variability of the main study factors in a hypothetical sample of 10 000 patients showed IONM to be the preferred strategy in 858 per cent of the population.ConclusionUse of IONM is cost-effective in patients undergoing bilateral thyroid surgery.Cost-effective in this scenario