caa a22 4500 44533374X CHVBK 20180317142746.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1245/s10434-011-1641-3 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1641-3 Financial and Clinical Implications of Low-Energy CT Combined with 99mTechnetium-Sestamibi SPECT for Primary Hyperparathyroidism [Elektronische Daten] [Giacomo Pata, Claudio Casella, Gian Magri, Silvia Lucchini, Maria Panarotto, Nicola Crea, Raffaele Giubbini, Bruno Salerni] Background: 99mTechnetium-sestamibi hybrid SPECT/CT has been favored over conventional SPECT in preoperative evaluation of primary hyperparathyroidism (PHPT) patients. However, the financial implications of CT-image acquisition have never before been published. This prompted us to perform a cost analysis of the aforementioned nuclear procedures. Methods: A total of 55 PHPT patients operated on between 2004 and 2009 were studied. Overall, 27 patients underwent SPECT and 28 SPECT/CT. Localization results, as well as diagnostic and clinical cost variations between SPECT and SPECT/CT patients, were compared. Results: SPECT/CT revealed higher sensitivity than SPECT (96.7 vs 79.3%; P=.011), as well as higher specificity (96.4 vs 82.4%; P=.037) and positive predictive value (PPV) (96.7 vs 83%; P=.038) for correctly identifying the neck-side affected by PHPT. Likewise, SPECT/CT disclosed higher sensitivity (86.7 vs 61.1%; P<.0001), specificity (97.4 vs 90%; P=.022), and PPV (86.7 vs 65.7%; P=.0001) for correct neck-quadrant identification. The mean operative time decreased from 62 min following SPECT to 36 min following SPECT/CT (P<.0001), yielding a mean surgical expense saving of 109.9 €/patient (updated at 2009/2010 billing database). SPECT/CT actually ensures a mean expenditure reduction of 98.7 €/patient (95% CI: 47.96 €-149.42 €), diagnostic costs variation amounting to 11.2 €/procedure. Conclusions: SPECT/CT ensures better focus for the surgical exploration, shortens surgical times, and eventually cuts costs when used for localization of parathyroid adenomas. Society of Surgical Oncology, 2011 Pata Giacomo Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut Casella Claudio Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut Magri Gian Department of Nuclear Medicine, Brescia Civic Hospital, Brescia, Italy aut Lucchini Silvia Chair of Nuclear Medicine, University of Brescia, Brescia, Italy aut Panarotto Maria Department of Nuclear Medicine, Brescia Civic Hospital, Brescia, Italy aut Crea Nicola Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut Giubbini Raffaele Department of Nuclear Medicine, Brescia Civic Hospital, Brescia, Italy aut Salerni Bruno Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut Annals of Surgical Oncology Springer-Verlag 18/9(2011-09-01), 2555-2563 1068-9265 18:9<2555 2011 18 10434 https://doi.org/10.1245/s10434-011-1641-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1641-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Pata Giacomo Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut NATIONALLICENCE 700 1- Casella Claudio Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut NATIONALLICENCE 700 1- Magri Gian Department of Nuclear Medicine, Brescia Civic Hospital, Brescia, Italy aut NATIONALLICENCE 700 1- Lucchini Silvia Chair of Nuclear Medicine, University of Brescia, Brescia, Italy aut NATIONALLICENCE 700 1- Panarotto Maria Department of Nuclear Medicine, Brescia Civic Hospital, Brescia, Italy aut NATIONALLICENCE 700 1- Crea Nicola Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut NATIONALLICENCE 700 1- Giubbini Raffaele Department of Nuclear Medicine, Brescia Civic Hospital, Brescia, Italy aut NATIONALLICENCE 700 1- Salerni Bruno Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Brescia, Italy aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/9(2011-09-01), 2555-2563 1068-9265 18:9<2555 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer