The Economics of Intraoperative Parathyroid Hormone Monitoring for Parathyroid Surgery: A Scoping Review of Cost Analyses and Economic Evaluations.

Objective: Intraoperative PTH (IOPTH) monitoring is recommended for primary hyperparathyroidism (PHPT), but questions surround its added clinical value and financial cost. We evaluated the methodological quality of economic evaluations investigating IOPTH monitoring in surgery for PHPT. Methods: We searched several databases, including MEDLINE and EMBASE, from January 1990 to June 2026. All screening was performed in duplicate. We included studies that conducted economic evaluations of IOPTH monitoring. Risk of bias (ROB) and methodological quality were evaluated in duplicate using ECOBIAS and CHEERS for full economic evaluations, while other criteria were applied to all eligible studies. We conducted a narrative synthesis with descriptive analysis. Results: Of the 668 articles reviewed, 22 articles met eligibility criteria. Most studies were observational (77%) and 14% were derived from decision tree models; 82% were partial economic evaluations and 18% were full economic evaluations. CHEERS adherence for full economic evaluation ranged from 46%-81%, and there was moderate/high ROB secondary to issues with reporting the time horizon, cost discounting, sensitivity analyses, and equity consideration biases. Economic perspective (14%), cost discounting (14%), economic summary measures (9%), and sensitivity analyses (23%) were infrequently reported. 50% of studies commented on IOPTH monitoring cost-effectiveness despite not investigating incremental economic summary measures. There was a similar number of studies reporting cost reductions and cost increases from the use of IOPTH monitoring. Conclusions: Knowledge gaps and methodological inadequacies impede our current understanding of the economics of IOPTH monitoring. The shortcomings identified should be addressed in future economic evaluations of intraoperative parathyroid technologies.