1. Financial and clinical implications of low-energy CT combined with 99m Technetium-sestamibi SPECT for primary hyperparathyroidism.
- Author
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Pata G, Casella C, Magri GC, Lucchini S, Panarotto MB, Crea N, Giubbini R, and Salerni B
- Subjects
- Adenoma diagnostic imaging, Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Hyperparathyroidism diagnostic imaging, Male, Middle Aged, Parathyroid Neoplasms diagnostic imaging, Prognosis, Radiopharmaceuticals, Sensitivity and Specificity, Survival Rate, Young Adult, Adenoma economics, Hyperparathyroidism economics, Parathyroid Neoplasms economics, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed
- Abstract
Background: (99m)Technetium-sestamibi hybrid SPECT/CT has been favored over conventional SPECT in preoperative evaluation of primary hyperparathyroidism (PHPT) patients. However, the financial implications of CT-image acquisition have never before been published. This prompted us to perform a cost analysis of the aforementioned nuclear procedures., Methods: A total of 55 PHPT patients operated on between 2004 and 2009 were studied. Overall, 27 patients underwent SPECT and 28 SPECT/CT. Localization results, as well as diagnostic and clinical cost variations between SPECT and SPECT/CT patients, were compared., Results: SPECT/CT revealed higher sensitivity than SPECT (96.7 vs 79.3%; P = .011), as well as higher specificity (96.4 vs 82.4%; P = .037) and positive predictive value (PPV) (96.7 vs 83%; P = .038) for correctly identifying the neck-side affected by PHPT. Likewise, SPECT/CT disclosed higher sensitivity (86.7 vs 61.1%; P < .0001), specificity (97.4 vs 90%; P = .022), and PPV (86.7 vs 65.7%; P = .0001) for correct neck-quadrant identification. The mean operative time decreased from 62 min following SPECT to 36 min following SPECT/CT (P < .0001), yielding a mean surgical expense saving of 109.9
/patient (updated at 2009/2010 billing database). SPECT/CT actually ensures a mean expenditure reduction of 98.7 /patient (95% CI: 47.96 -149.42 ), diagnostic costs variation amounting to 11.2 /procedure., Conclusions: SPECT/CT ensures better focus for the surgical exploration, shortens surgical times, and eventually cuts costs when used for localization of parathyroid adenomas. - Published
- 2011
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