Cost implications of different surgical management strategics for primary hyperparathyroidism

Background. Controversy exists about optimal management of patients with pr imary hyperparathyroidism. To date, no studies have explored the cost impli cations of variation in practice. Methods. Results from a national survey of endocrine surgeons were combined with results from a survey of endocrinologists and financial data from Med icare. Patterns of use of resources were identified, annual costs for the s urgical management of primary hyperparathyroidism in the United States were calculated, and the financial impact of variation in practice was estimate d Results. Survey respondents (n = 109) were experienced endocrine surgeons, performing an average of 33 parathyroidectomies annually. Seventy-five perc ent of patients undergo localization before initial exploration for primary hyperparathyroidism. In order of preference, these studies were sestamibi (43%), ultrasonography (28%), and sestamibi with single-photon emission com puted tomography (26%). Although there is variation in preoperative and pos toperative practice, in-hospital costs have the greatest influence on total cost. An estimated $282 million is spent annually in the United States on operations for primary hyperparathyroidism. National health expenditures co uld range by more than $70 million depending on whether management strategi es involving low or high use of resources are employed. Conclusions. Substantial variation among endocrine surgeons in the manageme nt of primary hyperparathyroidism has important cost implications. Implemen tation of evidence-based guidelines to optimize clinical and economic perfo rmance should be considered.