Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy

ABSTRACT: Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. Materials and methods: We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.

• Autores: Sanabria Quiroga, Álvaro Enrique; Ramírez Cuellar, Adonis Tupac
• Tipo de recurso: Article of investigation
• Fecha de publicación: 2015
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/43073
• Acceso en línea: https://hdl.handle.net/10495/43073
• Palabra clave: Cost-Benefit Analysis; Análisis Costo-Beneficio; Decision Support Techniques; Técnicas de Apoyo para la Decisión; Developing Countries; Países en Desarrollo; Electric Stimulation; Estimulación Eléctrica; Electromyography; Electromiografía; Intraoperative Complications; Complicaciones Intraoperatorias; Intraoperative Neurophysiological Monitoring; Monitorización Neurofisiológica Intraoperatoria; Intubation, Intratracheal; Intubación Intratraqueal; Length of Stay; Tiempo de Internación; Meta-Analysis as Topic; Metaanálisis como Asunto; Probability; Probabilidad; Recurrent Laryngeal Nerve; Nervio Laríngeo Recurrente; Thyroidectomy; Tiroidectomía; Tracheostomy; Traqueostomía; https://id.nlm.nih.gov/mesh/D003362; https://id.nlm.nih.gov/mesh/D003661; https://id.nlm.nih.gov/mesh/D003906; https://id.nlm.nih.gov/mesh/D004558; https://id.nlm.nih.gov/mesh/D004576; https://id.nlm.nih.gov/mesh/D007431; https://id.nlm.nih.gov/mesh/D064795; https://id.nlm.nih.gov/mesh/D007442; https://id.nlm.nih.gov/mesh/D007902; https://id.nlm.nih.gov/mesh/D015201; https://id.nlm.nih.gov/mesh/D011336; https://id.nlm.nih.gov/mesh/D012009; https://id.nlm.nih.gov/mesh/D013965; https://id.nlm.nih.gov/mesh/D014139
• Rights: openAccess
• License: http://creativecommons.org/licenses/by-nc-nd/2.5/co/