Ilaria Valentini, Basile Michele, Vescini Fabio, Borretta Giorgio, Chiodini Iacopo, Boniardi Marco, Carotti Marina, Castellano Elena, Cipriani Cristiana, Eller-Vainicher Cristina, Giannini Sandro, Iacobone Maurizio, Salcuni Antonio Stefano, Saponaro Federica, Spiezia Stefano, Versari Annibale, Zavatta Guido, Mitrova Zuzana, Saulle Rosella, Giovanazzi Alexia, Novizio Roberto, Paoletta Agostino, Papini Enrico, Persichetti Agnese, Samperi Irene, Scoppola Alessandro, Calò Pietro Giorgio, Cetani Filomena, Cianferotti Luisella, Corbetta Sabrina, De Rimini Maria Luisa, Falchetti Alberto, Laureti Stefano, Lombardi Celestino Pio, Madeo Bruno, Marcocci Claudio, Mazzaferro Sandro, Miele Vittorio, Minisola Salvatore, Palermo Andrea, Pepe Jessica, Scillitani Alfredo, Grimaldi Franco, Cozzi Renato, Attanasio Roberto
High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome - Italy.
Department of Medicine and Surgery, University of Perugia, Perugia - Italy.
Glob Reg Health Technol Assess. 2025 Jul 25;12:186-193. doi: 10.33393/grhta.2025.3531. eCollection 2025 Jan-Dec.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder, primarily caused by single adenomas or multiglandular disease. This study evaluates the economic impact of different PHPT treatment approaches from both the Italian National Health Service and societal perspectives.
A micro-costing approach was used to estimate the costs of surgical and non-surgical treatments. Data were gathered through a survey among panel members responsible for the Italian PHPT treatment guidelines, ensuring alignment with national clinical practice. The survey examined various cost components, including diagnostic tests, pre-hospitalization assessments, surgery duration, drug use, healthcare professionals involved, disposable materials, and follow-up care requirements.
The total cost for PHPT diagnosis and comorbidity assessment is € 887.96. Parathyroidectomy (PTX) costs € 4,588.00. Non-surgical alternatives, including pharmacological treatment (€ 953.34 annually) and active surveillance (€ 197.42 annually), result in cumulative 30-year costs of € 28,590 and € 5,910, respectively. Since PTX is typically performed at age 55, pharmacological treatment over 30 years incurs an additional € 22,876 per patient compared to surgery.
Despite its higher upfront cost, PTX demonstrated long-term cost efficiency due to the relatively low rates of follow-up complications and the absence of recurring annual costs associated with conservative strategies.
原发性甲状旁腺功能亢进症（PHPT）是一种常见的内分泌疾病，主要由单发腺瘤或多腺体疾病引起。本研究从意大利国家医疗服务体系和社会角度评估了不同PHPT治疗方法的经济影响。
采用微观成本核算方法估算手术和非手术治疗的成本。通过对负责意大利PHPT治疗指南的专家小组成员进行调查收集数据，确保与国家临床实践一致。该调查审查了各种成本组成部分，包括诊断测试、住院前评估、手术时长、药物使用、涉及的医疗专业人员、一次性材料以及后续护理要求。
PHPT诊断和合并症评估的总成本为887.96欧元。甲状旁腺切除术（PTX）成本为4588.00欧元。非手术替代方案，包括药物治疗（每年953.34欧元）和主动监测（每年197.42欧元），30年累计成本分别为28590欧元和5910欧元。由于PTX通常在55岁时进行，与手术相比，30年的药物治疗每位患者会产生额外的22876欧元费用。
尽管PTX前期成本较高，但由于随访并发症发生率相对较低且不存在与保守策略相关的年度重复成本，显示出长期成本效益。
