Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery

INTERNATIONAL JOURNAL OF SURGERY

卷:48

Article

Wang, Tie¹  Kim, Hoon Yub²  Wu, Che-Wei³  Rausei, Stefano⁴  Sun, Hui¹  Pergolizzi, Francesca Pia⁵  Dionigi, Gianlorenzo⁵ 

[1] Jilin Univ, China Japan Union Hosp, Div Thyroid Surg, Jilin Prov Key Lab Surg Translat Med, Changchun, Jilin, Peoples R China

[2] Korea Univ, Coll Med, Dept Surg, Seoul, South Korea

[3] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Kaohsiung Municipal Hsiao Kang Hosp, Coll Med,Fac Med,Dept Otolaryngol, Kaohsiung, Taiwan

[4] Osped Circolo Varese, Fdn Macchi, Varese, Italy

[5] Univ Messina, Univ Hosp G Martino, Dept Human Pathol Adulthood & Childhood G Barresi, Div Endocrine & Minimally Invas Surg, Via C Valeria 1, I-98125 Messina, Italy

关键词: Neural monitoring;    IONM;    Nerve injury;    Thyroid surgery;    Cost-effectiveness;   

DOI  :  10.1016/j.ijsu.2017.10.003

来源: Elsevier

【 摘 要 】

Purpose: The increasing use of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgery imposes an evaluation of cost-effectiveness. Methods: The analysis estimated the cost versus utility of different alternatives that simulate nerve injury course and the consequences for the following cohorts of patients: (1) no RLN injury, or vocal fold palsy (VCP) recovery within 1 month (2), 2 months (3), 6 months (4), and after 12 months (5). In the model applied, the average simulated cohort consisted of a young female patient, 40 years old, employed, daily voice user, who underwent elective, conventional total thyroidectomy via cervical incision using a standardized intermittent IONM technique, for an operable benign, bilateral, diffuse, multinodular, non-toxic, non-retrosternal goiter. Results: IONM was cost-ineffective when parameters such as the rates of transient vocal fold palsy (VCP) reached 38.5%. IONM was cost-effective if the rate of VCP was 33.6% at 1 month, 22.9% at 2 months, 9.8% at 6 months, and 3.8% at 12 months, independent of phono-surgery. The described scenario is cost-effective only in a highvolume setting. Conclusions: This study used simulation economic modeling to assess clinical and cost-effectiveness utility of IONM implementation. In light of the limitations of a simulation-based study, we conclusively assumed that IONM is cost-effective for permeant RLN injuries.

【 授权许可】

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