COST-EFFECTIVENESS OF PREOPERATIVE ULTRASOUND IN PRIMARY PARATHYROID SURGERY

A prospective, randomized, blind study was undertaken to assess whethe r preoperative ultrasound (US) localization of the abnormal parathyroi d glands is cost-effective in patients undergoing initial neck explora tion for primary hyperparathyroidism (PHPT). Twenty-eight patients wer e randomly allocated into two groups. In Group I the results of preope rative US were reported to the surgeon before exploration, and in Grou p II he was not informed of the US results. All patients underwent bil ateral neck exploration, performed by the same surgeon. The operating room time was recorded and the operating room costs calculated. They i ncluded the total costs of cervical US in Group I. The cure and morbid ity rates in Group I were 100 % and 14 % and those in Group II 86 % an d 7 %, respectively (P > 0.05). The mean operating room time of 97 +/- 15 min in Group I was significantly lower than that of 113 +/- 23 min in Group II (P < 0.05). The mean operating room costs, however, were almost the same in both groups being only 286 FIM higher in Group II ( P > 0.4) because the costs of preoperative US, the least expensive of the localization studies, of 497 FIM negated any cost savings achieved by the reduced operating room time. We thus conclude that preoperativ e US before initial neck exploration for PHPT is not cost-effective.