Cost-effectiveness of angiography-guided thyroidectomy to prevent postoperative hypoparathyroidism: Spanish National Health System model-based analysis.

BACKGROUND

Postoperative hypoparathyroidism is the most common complication after total thyroidectomy, and is associated with impaired quality of life and increased long-term healthcare use. Indocyanine green fluorescence imaging enables real-time intraoperative assessment of parathyroid perfusion, potentially improving gland preservation. However, its cost-effectiveness in routine surgical practice has not been formally evaluated.

METHODS

A model-based cost-effectiveness analysis was conducted comparing angiography-guided thyroidectomy with conventional thyroidectomy from the perspective of the Spanish National Health System. A state-transition Markov model simulated long-term outcomes for adults undergoing thyroidectomy, incorporating the incidence of transient and permanent hypoparathyroidism, health-related quality-adjusted life-years, and direct medical costs. The model used contemporary surgical data, included a 35-year time horizon, and discounted costs and effects at 3.5% annually. Probabilistic and deterministic sensitivity analyses were used to assess parameter and structural uncertainty. Cost-effectiveness was judged at a willingness-to-pay threshold of €30 000 per quality-adjusted life-year.

RESULTS

Angiography-guided thyroidectomy was associated with lower lifetime healthcare costs (€563.7 million versus €613.2 million) and greater health benefits (310 997 versus 299 107 quality-adjusted life-years), yielding a gain of 11 889 quality-adjusted life-years and €49.5 million in cost savings. Angiography-guided thyroidectomy dominated conventional thyroidectomy in all sensitivity analyses, with an incremental net monetary benefit of €406.2 million (95% uncertainty interval €381.7 million to €431.5 million). Scenario and joint probabilistic analyses confirmed robustness under alternative utility values and surgical outcomes.

CONCLUSION

Angiography-guided thyroidectomy may be a cost-saving innovation within publicly funded healthcare systems by reducing the incidence and chronic burden of postoperative hypoparathyroidism. These findings support broader adoption of fluorescence-guided surgery and underscore the need for real-world implementation studies to validate cost-effectiveness, and inform training and procurement strategies.