Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery. (December 2017)

• Record Type: Journal Article
• Authors: Wang, Tie; Kim, Hoon Yub; Wu, Che-Wei; Rausei, Stefano; Sun, Hui; Pergolizzi, Francesca Pia; Dionigi, Gianlorenzo
• Is Part Of: International journal of surgery. Volume 48(2017)
• Page Start: 180
• Page End: 188
• Publication Date: 2017-12
• Subjects: Neural monitoring -- IONM -- Nerve injury -- Thyroid surgery -- Cost-effectiveness; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.10.003
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Purpose: The increasing use of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgery imposes an evaluation of cost-effectiveness. Methods: The analysis estimated the cost versus utility of different alternatives that simulate nerve injury course and the consequences for the following cohorts of patients: (1) no RLN injury, or vocal fold palsy (VCP) recovery within 1 month (2), 2 months (3), 6 months (4), and after 12 months (5). In the model applied, the average simulated cohort consisted of a young female patient, 40 years old, employed, daily voice user, who underwent elective, conventional total thyroidectomy via cervical incision using a standardized intermittent IONM technique, for an operable benign, bilateral, diffuse, multinodular, non-toxic, non-retrosternal goiter. Results: IONM was cost-ineffective when parameters such as the rates of transient vocal fold palsy (VCP) reached 38.5%. IONM was cost-effective if the rate of VCP was 33.6% at 1 month, 22.9% at 2 months, 9.8% at 6 months, and 3.8% at 12 months, independent of phono-surgery. The described scenario is cost-effective only in a high-volume setting. Conclusions: This study used simulation economic modeling to assess clinical and cost-effectiveness utility of IONM implementation. In light of the limitations of a simulation-based study, we conclusively assumed that IONM is cost-effective for permeant RLN injuries. Highlights: Increasing use of IONM of the RLN during thyroid surgery imposes a cost-effectiveness evaluation. This study used simulation economic modeling to assess clinical and cost-effectiveness utility of IONM implementation. In light of the limitations of a simulation-based study, we conclusively assumed that IONM is cost-effective for permeant RLN injuries.