Razavi Christopher R, Tanavde Ved A, Kim Alexander S, Shaear Mohammad, Tufano Ralph P, Russell Jonathon O
Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Gland Surg. 2021 Feb;10(2):521-528. doi: 10.21037/gs-20-653.
As transoral endoscopic thyroidectomy vestibular approach grows in popularity, there is a need for data on cost in order to better characterize its value to patients. To this end, we compared the variable direct cost of transoral endoscopic thyroidectomy vestibular approach and transcervical approach thyroidectomy and determined which factors drive the increased cost for the transoral approach.
Patients undergoing thyroid lobectomy and total thyroidectomy that met inclusion criteria for transoral endoscopic thyroidectomy vestibular approach, including those patients that opted for management via the transcervical approach, between 8/2016 and 4/2019 were reviewed. The variable direct cost for the surgical encounter was collected and means were compared between the transoral and transcervical cohorts for lobectomy and total thyroidectomy respectively. The operative time independent variable direct cost was similarly compared between cohorts.
Out of 238 patients, 118 (50%) were managed via transoral endoscopic thyroidectomy vestibular approach and 120 (50%) were managed via transcervical approach thyroidectomy. Mean variable direct cost, our primary outcome, was $4,455 (SD 1,129, 95% CI: 4,204-4,706) for transoral lobectomy and $3,179 (SD 687, 95% CI: 2,990-3,369) for transcervical lobectomy [t(132.05)=8.09, P<0.001] representing a difference in cost of $1,276 (SD 158, 95% CI: 964-1,587). Mean variable direct cost was $4,681 (SD 829, 95% CI: 4,405-4,957) for transoral total thyroidectomy and $3,645 (SD 876, 95% CI: 3,431-3,858) for transcervical total thyroidectomy [t(79.92)=5.98, P<0.001], representing a difference in cost of $1,036 (SD 173, 95% CI: 691-1,381). Differences in energy devices alone account for $487.53 and $447.96 of the cost differences, respectively.
The differences in mean variable direct cost between transoral endoscopic vestibular approach and transcervical approach for lobectomy and total thyroidectomy were $1276 and $1036 respectively, amounts far less than some believe them to be. This data will be invaluable as we ultimately aim to define the value of transoral endoscopic thyroidectomy vestibular approach.
随着经口内镜甲状腺切除术前庭入路的普及，需要有关成本的数据，以便更好地评估其对患者的价值。为此，我们比较了经口内镜甲状腺切除术前庭入路和经颈入路甲状腺切除术的可变直接成本，并确定了哪些因素导致经口入路成本增加。
回顾了2016年8月至2019年4月期间接受甲状腺叶切除术和全甲状腺切除术且符合经口内镜甲状腺切除术前庭入路纳入标准的患者，包括那些选择经颈入路进行治疗的患者。收集手术过程中的可变直接成本，并分别比较经口和经颈队列中甲状腺叶切除术和全甲状腺切除术的成本均值。同样比较了队列之间手术时间独立变量直接成本。
在238例患者中，118例（50%）通过经口内镜甲状腺切除术前庭入路进行治疗，120例（50%）通过经颈入路甲状腺切除术进行治疗。我们的主要结果——平均可变直接成本，经口甲状腺叶切除术为4455美元（标准差1129，95%可信区间：4204 - 4706），经颈甲状腺叶切除术为3179美元（标准差687，95%可信区间：2990 - 3369）[t(132.05)=8.09，P<0.001]，成本差异为1276美元（标准差158，95%可信区间：964 - 1587）。经口全甲状腺切除术的平均可变直接成本为4681美元（标准差829，95%可信区间：4405 - 4957），经颈全甲状腺切除术为3645美元（标准差876，95%可信区间：3431 - 3858）[t(79.92)=5.98，P<0.001]，成本差异为1036美元（标准差173，95%可信区间：691 - 1381）。仅能量设备的差异分别占成本差异的487.53美元和447.96美元。
经口内镜前庭入路与经颈入路甲状腺叶切除术和全甲状腺切除术的平均可变直接成本差异分别为1276美元和1036美元，远低于一些人认为的数额。这些数据对于我们最终确定经口内镜甲状腺切除术前庭入路的价值将非常宝贵。
