ArticleBJS open2026
Cost-effectiveness of angiography-guided thyroidectomy to prevent postoperative hypoparathyroidism: Spanish National Health System model-based analysis.
Article in BJS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
backgroundPostoperative hypoparathyroidism is the most common complication after total thyroidectomy, and is associated with impaired quality of life and increased long-term healthcare use. Indocyanine green fluorescence imaging enables real-time intraoperative assessment of parathyroid perfusion, potentially improving gland preservation. However, its cost-effectiveness in routine surgical practice has not been formally evaluated.
methodsA model-based cost-effectiveness analysis was conducted comparing angiography-guided thyroidectomy with conventional thyroidectomy from the perspective of the Spanish National Health System. A state-transition Markov model simulated long-term outcomes for adults undergoing thyroidectomy, incorporating the incidence of transient and permanent hypoparathyroidism, health-related quality-adjusted life-years, and direct medical costs. The model used contemporary surgical data, included a 35-year time horizon, and discounted costs and effects at 3.5% annually. Probabilistic and deterministic sensitivity analyses were used to assess parameter and structural uncertainty. Cost-effectiveness was judged at a willingness-to-pay threshold of €30 000 per quality-adjusted life-year.
resultsAngiography-guided thyroidectomy was associated with lower lifetime healthcare costs (€563.7 million versus €613.2 million) and greater health benefits (310 997 versus 299 107 quality-adjusted life-years), yielding a gain of 11 889 quality-adjusted life-years and €49.5 million in cost savings. Angiography-guided thyroidectomy dominated conventional thyroidectomy in all sensitivity analyses, with an incremental net monetary benefit of €406.2 million (95% uncertainty interval €381.7 million to €431.5 million). Scenario and joint probabilistic analyses confirmed robustness under alternative utility values and surgical outcomes.
conclusionAngiography-guided thyroidectomy may be a cost-saving innovation within publicly funded healthcare systems by reducing the incidence and chronic burden of postoperative hypoparathyroidism. These findings support broader adoption of fluorescence-guided surgery and underscore the need for real-world implementation studies to validate cost-effectiveness, and inform training and procurement strategies.
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