Cost-effectiveness of near Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Introduction: Hypocalcemia is a common complication following total thyroidectomy due to inadvertent parathyroidectomy or devascularization. Near infrared autofluorescence (NIRAF) is a newer technology that aids in accurate intraoperative identification of parathyroid glands. In this study, we aim to estimate the cost-effectiveness of NIRAF relative to naked eye visualization of parathyroid glands during total thyroidectomy from a third-party payer perspective.

Methods: A decision tree was used to model costs, quality adjusted life years (QALY), and cost-effectiveness of NIRAF. The decision tree was parameterized using best available literature on probability of hypocalcemia (permanent and transient), likelihood of hospitalization, the cost of treatment for hypocalcemia, and utilities for transient and permanent hypocalcemia. Since reimbursement for NIRAF is not known, we assumed a base case value and performed extensive sensitivity analyses. Expected costs and utility were estimated over a one-year time horizon, and cost-effectiveness was measured using the incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of $100,000 per QALY gained was assumed.

Results: In the base case, the expected one-year cost for naked eye visualization was $250.48, which was lower than that of NIRAF ($666.70). However, NIRAF yielded more QALYs (0.9836 vs. 0.9754). ICER for NIRAF was $50,759 per QALY gained, which is below the willingness-to-pay threshold. Sensitivity analyses suggested that NIRAF remained cost-effective as long as the price remained below $909. Furthermore, the base case result remained robust to changes in other model parameters, including probabilities of transient and permanent hypocalcemia and cost of treatment.

Conclusions: NIRAF is likely to be cost-effective from a payer perspective for patients receiving total thyroidectomy. This tool can be utilized to decrease incidence of hypocalcemia and subsequent burden on patients. To our knowledge, this is the first cost-effectiveness analysis of NIRAF during total thyroidectomy.