Financial and Clinical Implications of Low-Energy CT Combined with 99mTechnetium-Sestamibi SPECT for Primary Hyperparathyroidism

Abstract

(99m)Technetium-sestamibi hybrid SPECT/CT has been favored over conventional SPECT in preoperative evaluation of primary hyperparathyroidism (PHPT) patients. However, the financial implications of CT-image acquisition have never before been published. This prompted us to perform a cost analysis of the aforementioned nuclear procedures. A total of 55 PHPT patients operated on between 2004 and 2009 were studied. Overall, 27 patients underwent SPECT and 28 SPECT/CT. Localization results, as well as diagnostic and clinical cost variations between SPECT and SPECT/CT patients, were compared. SPECT/CT revealed higher sensitivity than SPECT (96.7 vs 79.3%; P=.011), as well as higher specificity (96.4 vs 82.4%; P=.037) and positive predictive value (PPV) (96.7 vs 83%; P=.038) for correctly identifying the neck-side affected by PHPT. Likewise, SPECT/CT disclosed higher sensitivity (86.7 vs 61.1%; P<.0001), specificity (97.4 vs 90%; P=.022), and PPV (86.7 vs 65.7%; P=.0001) for correct neck-quadrant identification. The mean operative time decreased from 62 min following SPECT to 36 min following SPECT/CT (P<.0001), yielding a mean surgical expense saving of 109.9 <euro>/patient (updated at 2009/2010 billing database). SPECT/CT actually ensures a mean expenditure reduction of 98.7 <euro>/patient (95% CI: 47.96 <euro>-149.42 <euro>), diagnostic costs variation amounting to 11.2 <euro>/procedure. SPECT/CT ensures better focus for the surgical exploration, shortens surgical times, and eventually cuts costs when used for localization of parathyroid adenomas.