Cost-Effectiveness of Parathyroidectomy for Primary Hyperparathyroidism

Cost-effectiveness analysis (CEA) is a method to assess the outcomes of various treatment options when the costs incurred and the subsequent changes in the quality of life (QOL) are known. Guidelines for formal CEA were outlined by the Panel on Cost-Effectiveness in Health and Medicine in 1996 [1]. Many studies in the literature claim to evaluate cost-effectiveness, but often they fail to conform to these guidelines and are therefore not considered formal analyses. Formal CEA looks at a problem not by the charges incurred, but by the actual costs. CEA can be performed from any of several perspectives: for example, the hospital, the patient, the society, or the third-party payer. CEA can be used to compare the effects of two or more competing strategies to determine which one is less costly and/or more effective. CEA asks the question, “How much does it cost to save 1 year of healthy life?” Comparisons between two or more interventions are expressed as incremental cost-effectiveness ratios (ICERs) and the units are dollars per quality-adjusted life year (QALY). Sensitivity analysis is performed to determine the level of uncertainty of the results. Each variable can be changed either individually or simultaneously to determine the cumulative impact of errors on the final conclusion. CEA is not a substitute for head-to-head analyses of competing treatment regimens in prospective trials, nor is it designed to make treatment decisions for individual patients.