Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia

Abstract

Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental costeffectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.Key Words: Thyroid neoplasm, thyroidectomy, hypocalcaemia, cost-benefit (source: MeSH, NLM). RESUMENObjetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce 804

Meta-analysis of routine calcium/vitamin D3 supplementationversusserum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy

“…There are case reports of hypercalcaemia related to high doses of calcium or vitamin D3 supplementation, but this is uncommon and can be controlled easily by decreasing the calcium dose. Cost‐effectiveness is not a problem, as this approach has been shown to be efficient in different healthcare systems.…”

An intact parathyroid hormone–based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy

“…Only 83 (13.4%) of our patients were prescribed calcitriol, based on the protocol. Taking into account only the cost of the prescription, 87.6% of our patients saved a total of $23,134 per month, by not routinely being prescribed calcitriol [25]. Some studies favor routine supplementation, as the optimal algorithm is unknown.…”

“…Some studies favor routine supplementation, as the optimal algorithm is unknown. Cost-analysis studies suggest that either prophylactic treatment with vitamin D or metabolites and calcium, or calcium alone or routine supplementation, is cost effective [25, 26]. Even with routine vitamin D administration with calcium, patients pay on average one half the cost of emergency room visitation and evaluation, and evaluation and treatment during a one-day hospital readmission is more than three times the cost [25].…”

“…Cost-analysis studies suggest that either prophylactic treatment with vitamin D or metabolites and calcium, or calcium alone or routine supplementation, is cost effective [25, 26]. Even with routine vitamin D administration with calcium, patients pay on average one half the cost of emergency room visitation and evaluation, and evaluation and treatment during a one-day hospital readmission is more than three times the cost [25]. Tartaglia et al demonstrated the effectiveness of prophylactic calcium therapy; however due to their inability to perform iPTH testing, all patients received vitamin D [16].…”

Costo-efectividad de las intervenciones nutricias y dietéticas en salud

“…Los resultados muestran que la intervención resulto ser costo-efectiva con un costo por suplementar de 79 000 dólares y un costo por no suplementar de 711 000 dólares por cada 1000 mujeres. Sanabria et al (2011) elaboraron el estudio de simulación con pacientes con tiroidectomía. Se llevó a cabo una intervención con vitamina D, otra con calcio y en otro grupo no se dio intervención.…”