J Endocr Surg.  2018 Mar;18(1):10-20. 10.16956/jes.2018.18.1.10.

Cost-Effectiveness Estimate for Neural Monitoring in Thyroid Surgery

• Kim HY
• Chai YJ
• Freni F
• Makay O
• Galletti B
• Galletti F
• Sun H
• Dionigi G
• The Korean Intraoperative Neural Monitoring Society (KINMoS)

• KMID: 2414419
• DOI: http://doi.org/10.16956/jes.2018.18.1.10

Abstract

There is growing evidence for the importance of more detailed cost evaluation of new technologies used in surgery. The innovative impact of technology holds the potential to achieve transformative clinical improvements. Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. Cost-effectiveness studies have been the most established and studied methods for evaluation in surgical patients. Limited information exists regarding the cost-effectiveness of new surgical strategies for monitored thyroid surgeries. We describe the recent evidence regarding methods of evaluation of cost-effectiveness structures and function for intraoperative neural monitoring (IONM) in thyroid surgery. Our findings suggest that health economics modeling to inform the design of a cost-effectiveness studies looking at IONM has been demonstrated to be feasible as a method for improving research efficiency.

Keyword

Thyroid surgery; Neural monitoring; Cost-effectiveness analysis

MeSH Terms

Cost-Benefit Analysis
Health Services Research
Humans
Methods
Thyroid Gland*

Figure

• 

  Fig. 1 Prevalence of IONM in Italy. Data from Italian consumption of electromyogram tubes. About 38 to 40,000 thyroidectomies per year are performed in Italy, that is about 16% are monitored. IONM = intraoperative neural monitoring.

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  Fig. 2 Cost per RLN injury. Expense are sensitive to time-recovery (i.e., severity) of RLN injury. Figures are higher for thyroid malignant disease than benign surgery. Charges in the case of vocal cord surgery are higher than no medications. Both costs incurred by patient and NHS are significant (figure adapted from reference 27). Each clinical pathway means follow as: clinical pathway 1, RLN function recovery <1 month; clinical pathway 2, RLN function recovery ≥1 month and <3 months; clinical pathway 3, RLN function recovery ≥3 months and <6 months; clinical pathway 4, RLN function recovery ≥6 months and <12 months; clinical pathway 4, RLN function recovery ≥12 months, with phono surgery. RLN = recurrent laryngeal nerve; NHS = National Healthcare System.

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  Fig. 3 IONM cost-effectiveness challenges. IONM = intraoperative neural monitoring; RLNP = recurrent laryngeal nerve palsy.

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