Cost-Effectiveness of Parathyroid Cryopreservation and Autotransplantation

作者：Frye CC, Sullivan J, Sanka SA, Smith ER, Goetz B, Brunt LM, Gillanders W, Brown TC, Olson JA, Hall B, Pandian TK · 发表于：JAMA surgery · 年份：2024 · DOI：10.1001/jamasurg.2024.0175

IMPORTANCE: Delayed autotransplantation of cryopreserved parathyroid tissue (DACP) is the only surgical treatment for permanent postoperative hypoparathyroidism. Studies suggest that only a small minority of cryopreserved samples are ultimately autotransplanted with highly variable outcomes. For these reasons, many have questioned the economic utility of the process, although, to the authors' knowledge, this has never been formally studied. OBJECTIVE: To report the clinical outcomes of parathyroid cryopreservation and DACP at a large academic institution and to determine the cost-effectiveness of this treatment. DESIGN, SETTING, AND PARTICIPANTS: An institutional review board-approved, retrospective review of patients at a single institution who underwent DACP over a 17-year period was conducted with a median follow-up of 48.2 months. A forward-looking cost-utility analysis was then performed to determine the economic utility of cryopreservation/DACP vs usual care (monitoring and supplementation). Patients who had parathyroid tissue in cryopreserved storage between August 2005 to September 2022 at a single-center, academic, quaternary care center were identified. EXPOSURE: Parathyroid cryopreservation and DACP. MAIN OUTCOMES AND MEASURES: Graft functionality, clinical outcomes, and cost utility using a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY). RESULTS: A total of 591 patients underwent cryopreservation. Of these, 10 patients (1.7%; m...