Cost-Benefit Analysis of Intraoperative Autofluorescence for Parathyroid Identification

Importance Hypoparathyroidism (hypoPT) is the most common complication post–total thyroidectomy and is associated with increased morbidity and mortality when chronic. Conventionally, the prevention of hypoPT has involved visual inspection of parathyroid glands; however, near-infrared autofluorescence detection systems have been recently used as adjuncts. These systems involve significant outlay and ongoing costs. Objective To evaluate the cost-effectiveness of autofluorescence for hypoPT prevention and to determine the chronic hypoPT rate at which this technology would become economically feasible. Design, Setting, and Participants In this cost-benefit analysis, a decision tree economic model was developed to compare thyroidectomies performed with autofluorescence to visual inspection only. All costs associated with conventional surgery, autofluorescence, and the costs of managing hypoPT were captured. Morbidity was defined in terms of disutility, quantified as quality-adjusted life-years, determined over a lifetime time horizon. The model was used to calculate the incremental cost-effectiveness ratio for autofluorescence-guided surgery and to identify determinants that influenced this ratio, and hence the economic feasibility of the use of autofluorescence. This study was based on the health care setting in Australia, in which more than 3500 thyroidectomies are performed annually. A probe-based autofluorescence detection system was used for analysis based on its availability in Australia. All costs were quantified in Australian dollars (A$) and were adjusted for 2024. The study data spanned from June 2022 to May 2023, and the data were analyzed in June 2023. Results The economic model analysis indicated that autofluorescence involved an additional cost of A $1024 (US $639) per surgery, offset by an increase in quality-adjusted life-years of 0.0080, resulting in an incremental cost-effectiveness ratio of A $128 234 (US $80 060). In Australia, it is generally assumed that interventions with a ratio of up to A $70 000 (US $43 703) may be considered cost-effective. Cost-effectiveness was most sensitive to a change in the overall hypoPT rate, chronic hypoPT rate, and the efficacy of autofluorescence. Autofluorescence-guided surgery achieved the cost-effectiveness threshold at a chronic hypoPT rate of greater than or equal to 5%. Conclusions and Relevance Although the use of autofluorescence involves significant costs, its economic feasibility for the prevention of postsurgical hypoPT is determined by the underlying chronic and overall hypoPT rate, as well as the efficacy of autofluorescence for the reduction of hypoPT. The findings of this cost-benefit analysis are relevant in determining the prioritization and allocation of finite health care resources.