THE ECTOPIC PARATHYROID ADENOMA - A COST JUSTIFICATION FOR ROUTINE PREOPERATIVE LOCALIZATION WITH TECHNETIUM TC 99M SESTAMIBI SCAN

Objectives: To evaluate the cumulative costs of failure to identify th e ectopic parathyroid adenoma when exploration without preoperative lo calization is performed and to compare these costs with the expenses o f routine preoperative localization in every patient. Design: A consec utive series of 59 patients with primary hyperparathyroidism studied w ith preoperative scans using technetium Tc 99m sestamibi and ultrasoun d was submitted to a cost analysis. A subset of 5 cases of ectopic ade nomas, presumed to be unidentifiable on routine surgery, was similarly analyzed. Setting: Academic tertiary referral center. Methods: The op erative, anesthesia, hospitalization, imaging, and physician reimburse ment costs of a failed exploration are compared with the costs of preo perative technetium Tc 99m sestamibi and ultrasound scans in every pat ient. Results: Two cases of mediastinal parathyroid adenomas in this c onsecutive series of 59 patients were given a theoretical cost, includ ing hospitalization, physician reimbursement, and anesthesia fees. The se costs were based on a failed cervical exploration and extracted fro m the record of an actual patient who underwent such a process at the University of Vermont, Burlington, in 1995. In addition, the records o f 2 patients with intrathyroidal adenomas were submitted to the same t heoretical cost analysis with the exception that these patients were a ssumed to have adenomas that could be discovered after prolonged cervi cal exploration and thyroid lobectomy. The net management and imaging costs for 4 cases of ectopic parathyroid adenomas undergoing theoretic al failed exploration are compared with the cost of obtaining routine technetium Tc 99m sestamibi and ultrasound scans for each of the 59 pa tients. Conclusion: The added cost of protracted or failed cervical ex ploration nearly neutralized the costs of a routine preoperative local ization with technetium Tc 99m sestamibi and ultrasound scans.