Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery

Tie Wang, Hoon Yub Kim, Che Wei Wu, Stefano Rausei, Hui Sun, Francesca Pia Pergolizzi, Gianlorenzo Dionigi

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)180-188
Number of pages9
JournalInternational Journal of Surgery
Volume48
DOIs
Publication statusPublished - 2017 Dec 1

Keywords

  • Cost-effectiveness
  • IONM
  • Nerve injury
  • Neural monitoring
  • Thyroid surgery

ASJC Scopus subject areas

  • Surgery

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