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2010 Annual Meeting Abstracts
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To Supplement Or Not To Supplement: A Cost-Utility Analysis Of Calcium And Vitamin D Repletion In Post-Thyroidectomy Patients
*Tracy S Wang1, *Kevin Cheung2, Sanziana A Roman3, Julie Ann Sosa3
1Medical College of Wisconsin, Milwaukee, WI;2McMaster University, Hamilton, ON, Canada3Yale University, New Haven, CT
Objective: To determine the incremental cost-utility of routine vs. selective calcium and vitamin D supplementation after total/completion thyroidectomy.
Design: Cost-utility analysis using a Markov decision model. Input data were obtained from the literature and Medicare Reimbursement Schedule. Sensitivity analyses were performed for clinically relevant inputs.
Setting: Hypothetical clinical setting for prevention/treatment of potential hypocalcemia. This is the most common post-thyroidectomy complication and is an area of ongoing debate and research.
Patients: A cohort of adult post-thyroidectomy patients.
Interventions: Routine or selective supplementation of oral calcium carbonate, vitamin D (calcitriol), and intravenous calcium gluconate, when required. Selective supplementation was determined by patient symptoms and/or serum calcium and intact parathyroid hormone (PTH) levels.
Main Outcome Measures: Cost-utility, measured in U.S. dollars/quality-adjusted-life-year ($/QALY).
Results: In the base-case analysis, the cost of routine supplementation was $721 vs. $1147 for selective PTH/symptoms-based supplementation. Patients in the routine arm gained 0.0004 QALYs compared to patients in the selective arm (0.97352 QALYs vs. 0.97316 QALYs). At the population level, this translates into a savings of $1.1 million/QALY for routine supplementation. Sensitivity analyses demonstrated that the model was most sensitive to the utility of the hypocalcemic state, the post-operative rates of hypocalcemia (higher rates of transient hypocalcemia gaining utility in the routine supplementation arm; lower rates gaining in the selective arm), the cost of longer hospital stays, and the cost of serum PTH testing.
Conclusions: Routine oral calcium and calcitriol supplementation in post-thyroidectomy patients appears to be less expensive and results in higher patient utility than selective supplementation. High-volume surgeons who have very low rates of hypocalcemia benefit less from routine supplementation.
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