Cost-effectiveness of Near-infrared Autofluorescence (NIRAF) in Total Thyroidectomy

OBJECTIVE: Hypocalcemia is a common complication following total thyroidectomy. Near-infrared autofluorescence (NIRAF) is a newer technology that aids in intraoperative identification of parathyroid glands. In this study, we aim to estimate the cost-effectiveness of NIRAF relative to naked-eye visualization of parathyroid glands during total thyroidectomy from a third-party payor perspective. STUDY DESIGN: Cost-effectiveness analysis. SETTING: Decision analysis. METHODS: A decision tree was used to model costs, quality-adjusted life years (QALY), and cost-effectiveness of NIRAF. The model was parameterized using the best available literature on the probability of hypocalcemia, likelihood of hospitalization, cost of treatment for hypocalcemia, and utilities for transient and permanent hypocalcemia. Expected costs and utility were estimated over a 1-year time horizon, and cost-effectiveness was measured using the incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100,000 per additional QALY gained. RESULTS: In the base case, the expected 1-year cost for naked-eye thyroidectomy was $122.51, which was lower than that of NIRAF ($566.99). NIRAF yielded more QALYs (0.994 vs. 0.989). The ICER for NIRAF was $85,042 per QALY gained, which is below the assumed willingness-to-pay threshold. Sensitivity analyses suggested that NIRAF remained cost-effective, as long as the price remained below $578.00. CONCLUSIONS: Cost-effectiveness of NIRAF is highly sensitive to the price and a payor's willingness-to-pay threshold as well as the true rate of transient or permanent hypocalcemia. To our knowledge, this is the first cost-effectiveness analysis of NIRAF during total thyroidectomy in the United States.