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Randomized Controlled Trial
. 2019 Nov;41(11):3940-3947.
doi: 10.1002/hed.25934. Epub 2019 Aug 31.

Cost-effectiveness in transient hypocalcemia post-thyroidectomy

Giuseppe Mercante  1   2 , Andrea Anelli  3 , Diana Giannarelli  4 , Davide Giordano  5 , Ilenia Sinopoli  3 , Fabio Ferreli  2 , Giovanna Digiesi  6 , Maria L Appetecchia  7 , Agnese Barnabei  7 , Giovanni Cristalli  3 , Laura Conti  6 , Raul Pellini  3 , Fabio Piazza  8 , Davide Lombardi  9 , Armando De Virgilio  1   2 , Giuseppe Spriano  1   2
Affiliations
Randomized Controlled Trial

Cost-effectiveness in transient hypocalcemia post-thyroidectomy

Giuseppe Mercante et al. Head Neck. 2019 Nov.

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.

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References

REFERENCES

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