Department of Endocrine Surgery, Hôpital Privé de Provence, Aix-en-Provence, France.
Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France.
Front Endocrinol (Lausanne). 2023 Jun 28;14:1193290. doi: 10.3389/fendo.2023.1193290. eCollection 2023.
Hypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France.
Based on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively.
Among the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004).
Our study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.
甲状旁腺功能减退症是甲状腺癌全切术后最常见的并发症，需要补充钙和/或维生素 D，且时间不确定。目前尚未评估该并发症相关的额外成本。本研究旨在评估法国甲状腺癌全切术后甲状旁腺功能减退症的经济负担。
基于法国国家癌症队列，该队列从法国国家健康数据系统（SNDS）提取数据，确定了 2011 年至 2015 年间在法国接受甲状腺癌全切术的所有成年患者，并比较了他们术后第一年的医疗资源使用情况，根据他们是否在术后接受钙和/或维生素 D 治疗。使用非参数 Wilcoxon 检验和广义线性模型（伽马分布和对数链接）分别进行单变量和多变量成本分析。
在分析的 31175 名患者中（75%为女性，中位年龄：52 岁），13247 名（42%）在术后 1 个月内开始补充钙和/或维生素 D，2855 名（9.1%）在 1 年后仍在接受治疗。在术后第一年，治疗组患者的总支出和特定健康支出均明显高于未治疗组患者：每位患者分别为 7233 欧元和 6934 欧元（p<0.0001）和 478.6 欧元和 332.7 欧元（p<0.0001）。在调整年龄、性别、Charlson 合并症指数、生态剥夺指数、甲状腺切除术类型、淋巴结清扫术和并发症、年份和地区后，整体医疗保健利用的增量成本为 142 欧元（p<0.004）。
本研究发现，甲状腺癌全切术后甲状旁腺功能减退症患者在术后第一年的健康支出方面存在显著的额外成本。计划进行 5 年随访，以评估更严重的长期并发症对成本的影响。
