Comparison of single photon emission CT (SPECT) with SPECT/CT imaging in preoperative localization of parathyroid adenomas: A cost‐effectiveness analysis. (5th February 2016) - Barber, Brittany
Abstract: Background: Controversy exists regarding the superiority of single photon emission CT (SPECT)/CT over SPECT for preoperative localization of parathyroid adenomas in primary hyperparathyroidism (PHPT), as well as the cost‐effectiveness. Methods: A retrospective review was undertaken of patients undergoing surgery for PHPT from January 2009 to August 2014. Ultrasound and SPECT (ultrasound‐SPECT) or SPECT/CT (ultrasound‐SPECT/CT) were performed for each patient. Sensitivity and positive predictive value (PPV) of each modality were calculated. Cost‐effectiveness was determined by an incremental cost‐effectiveness ratio (ICER) analysis. Results: Two hundred fifty‐nine patients with 266 parathyroid adenomas were included in the study. Lateralization sensitivity and PPV of ultrasound‐SPECT were 85.1% and 98.2%, respectively. The lateralization sensitivity and PPV of ultrasound‐SPECT/CT were 86.9% and 99.4%, respectively. A cost of $2499.22 (CAD) per additional parathyroid adenoma detection by ultrasound‐SPECT/CT was determined from the ICER analysis. Conclusion: Similar sensitivities and PPVs were observed between ultrasound‐SPECT and ultrasound‐SPECT/CT in preoperatively lateralizing parathyroid adenomas, with relatively equivalent cost‐effectiveness. © 2016 Wiley Periodicals, Inc. Head Neck 38 : E2062–E2065, 2016