Evidence map›Paper›PMID 28929381›Full record

ArticleWorld journal of surgery2018

Recombinant Parathyroid Hormone Versus Usual Care: Do the Outcomes Justify the Cost?

Kathryn H Chomsky-Higgins, Holly M Rochefort, Carolyn D Seib, Jessica E Gosnell, Wen T Shen, Quan-Yang Duh, Insoo Suh

Abstract read
PubMed Publisher
In one paragraph

Article in World journal of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Parathyroid Allotransplantation: A Systematic Review.Medical sciences (Basel, Switzerland) · 2022
    Pooled it
  2. Article
  3. Review
  4. Article
  5. Shifting Trends and Informed Decision-Making in the Management of Graves' Disease.Thyroid : official journal of the American Thyroid Association · 2020
    Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Kathryn H Chomsky-HigginsDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA. kate.chomsky-higgins@ucsf.edu.
Holly M RochefortDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA.
Carolyn D SeibDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA.
Jessica E GosnellDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA.
Wen T ShenDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA.
Quan-Yang DuhDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA.
Insoo SuhDepartment of Surgery, Section of Endocrine Surgery, University of California, San Francisco, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94143, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHypoparathyroidism is a potential outcome of anterior neck surgery. Commonly it is managed by calcium and vitamin D supplementation in large doses, with attendant side effects. A recombinant human parathyroid hormone (rhPTH) is now available in the USA, offering a potentially more effective treatment. No cost-effectiveness model investigating this new medication versus standard care has yet been published.

methodsWe constructed a decision analytic model comparing usual care versus rhPTH treatment for postsurgical hypoparathyroidism. Threshold and sensitivity analyses on key parameters were conducted to assess robustness of the model. Costs and health outcomes were represented in US dollars and quality-adjusted life-years (QALYs).

resultsThe rhPTH strategy was both more costly and more effective than the usual care (UC) strategy. In the base case, UC cost $37,196 and provided 7.54 QALYs. The rhPTH strategy cost $777,224 and provided 8.46 QALYs for an incremental cost-effectiveness ratio of $804,378/QALY. As this was above our willingness-to-pay of $100,000, treatment with rhPTH was not considered cost-effective. The model was robust to all other parameters.

conclusionsTo our knowledge, this is the first formal cost-effectiveness analysis of rhPTH in comparison with UC. Our model suggests that although the new treatment is slightly more effective than UC, the modest gain in quality of life for patients who are reasonably well-managed by UC does not justify the cost. However, consideration must be given to rhPTH for patients who have failed UC, as the expenditure may be justified in that context.

Indexed as

CalciumCost-Benefit AnalysisDietary SupplementsFemaleHumansHypoparathyroidismMaleModels, TheoreticalParathyroid HormoneQuality-Adjusted Life YearsQuality of LifeRecombinant ProteinsVitamin DCalciumParathyroid HormoneRecombinant ProteinsVitamin D

Identifiers

PMID28929381

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.