Less is more: how pet/ct can replace three preoperative diagnostics for patients suffering from primary hyperparathyroidism
Sietse van Mossel (TNW-BMPI), Sopany Saing (BMS-HTSR), Natasha Appelman-Dijkstra (LUMC), Elske Quak (Centre François Baclesse), Abbey Schepers (LUMC), Frits Smit (LUMC), Lioe-Fee de Geus-Oei (TNW-BMPI), Dennis Vriens (Radboud UMC)
Abstract
Objective: We conducted a cost-effectiveness analysis comparing a preoperative one-stop-shop PET/CT imaging strategy with current best practice in which PET/CT is only recommended after negative or inconclusive ultrasonography and SPECT/CT for patients suffering from primary hyperparathyroidism. We investigated whether the one-stop-shop strategy performs as well as current best practice but at lower costs.
Methods: We developed a cohort-level state transition model reflecting patients’ hospital journeys after primary referral for biochemically diagnosed hyperparathyroidism. A cycle length of twelve months and a lifetime horizon were used. We conducted probabilistic analyses simulating 50,000 cohorts to assess joint parameter uncertainty. The incremental net monetary benefit and cost for each quality-adjusted life year were estimated.
Results: The simulated health effects were similar for both imaging strategies. Accordingly, the one-stop-shop imaging strategy did not result in reduced patient outcomes. A tariff of €885 for PET/CT (from skull-base to heart-base) was required to be cost saving compared to current best practice. The decision to implement either imaging strategy depended on available local resources as well as meeting patient preferences. The one-stop-shop strategy reduced the number of hospital visits, travel times, waiting times, hospital waste and radiation burden, and enabled easy resource capacity allocation. All fundamentally preferable regarding logistics, environmental impact and interference in patients’ lives.
Conclusion: One-stop-shop imaging with PET/CT can replace three preoperative diagnostic procedures. Daily clinical practice grounds including available capacity allocation and patient preferences should inform policy-making on whether a hospital should implement the one-stop-shop strategy.
Keywords: hyperparathyroidism, parathyroid, PET/CT, ultrasonography, SPECT/CT, cost-effectiveness