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THE HARMONIC STUDY: COST-EFFECTIVENESS EVALUATION OF THE USE OF THE ULTRASONIC SCALPEL IN TOTAL THYROIDECTOMY

Published online by Cambridge University Press:  14 September 2012

Matteo Ruggeri ,
Rossella Dibidino ,
Marco Marchetti ,
Celestino Pio Lombardi ,
Marco Raffaelli  and
Americo Cicchetti
Matteo Ruggeri
Affiliation:
Università Cattolica del Sacro Cuore email: mruggeri@rm.unicatt.it
Rossella Dibidino
Affiliation:
Università Cattolica del Sacro Cuore
Marco Marchetti
Affiliation:
Università Cattolica del Sacro Cuore
Celestino Pio Lombardi
Affiliation:
Università Cattolica del Sacro Cuore
Marco Raffaelli
Affiliation:
Università Cattolica del Sacro Cuore
Americo Cicchetti
Affiliation:
Università Cattolica del Sacro Cuore
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Abstract

Background: Total thyroidectomy (TT) can be performed either with the traditional technique or using the ultrasound scalpel. Here, the use of the ultrasound scalpel is investigated in order to assess cost-effectiveness from an hospital, third party payer and societal perspective.

Methods: A randomized controlled trial was conducted at the University Hospital A. Gemelli in Rome. Data refer to 198 patients, randomized to either surgery with the ultrasound scalpel (n = 96) or traditional (n = 102) and followed for 3 months after hospital discharge. Operation time (OT) and resource consumption were recorded. Main clinical outcome investigated was quality of life (evaluated with EQ-5D).

Results: A shorter operation time (traditional: 76.36 vs ultrasound: 54.16 minutes, p < 0.001) was observed. 3 months after surgery, differences in QoL were significant (0.91 vs 0.84, p = 0.002). Concerning the hospital perspective, ultrasound scalpel allows savings of 119 EUR per patient. From a societal perspective, ultrasound scalpel is also related to lower medical resource consumption during a 3 month follow-up after discharge (traditional: 129.03 EUR vs ultrasound: 107.82 EUR) and lower non-medical resource utilization (transport/hotels costs traditional:535.51 EUR vs ultrasound: 342.77 EUR. No statistical difference was found in productivity losses up to 3 months (traditional: 377.71 EUR vs ultrasound: 385.51 EUR).

Conclusion: Allowing an overall saving of 325.36 EUR per patient, Ultrasound scalpel should be adopted for TT procedures in the “A.Gemelli” University hospital.

Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 3 , July 2012 , pp. 259 - 264
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Amaral, JF. The experimental development of an ultrasonically activated scalpel for laparoscopic use. Surg Laparosc Endosc. 1994;4:92–99.Google ScholarPubMed
2.Amaral, JF, Chrostek, C. Depth of thermal injury: Ultrasonically activated scalpel vs. electrosurgery. Surg Endosc. 1995;9:226.Google Scholar
3.Bellantone, R, Lompardi, CP, Bossola, M, et al.Total thyroidectomy for management of benign thyroid disease: Review of 526 cases. World J Surg. 2002;26:1468–1471.CrossRefGoogle ScholarPubMed
4.Briggs, A. Statistical approaches to handling uncertainty in health economic evaluation. Eur J Gastroenterol Hepatol. 2004;16:551–561.CrossRefGoogle ScholarPubMed
5.Briggs, A. Probabilistic analysis of cost-effectiveness models: Statistical representation of parameter uncertainty. Value Health. 2005;8:1–2.CrossRefGoogle ScholarPubMed
6.Claxton, K, Sculpher, M, McCabe, C, et al.Probabilistic sensitivity analysis for NICE technology assessment: Not an optional extra. Health Econ. 2005;14:339–347.CrossRefGoogle ScholarPubMed
7.Cordón, C, Fajardo, R, Ramirez, J, Herrera, MF. A randomised, prospective, parallel group study comparing the harmonic scalpel to electrocautery in thyroidectomy. Surgery. 2005;137:337–341.CrossRefGoogle Scholar
8.Defechereux, T, Rinken, F, Maweja, S, Hamoir, E, Meurisse, M. Evaluation of the ultrasonic dissector in thyroid surgery. A prospective randomised study. Acta Chir Belg. 2003;103:274–277.CrossRefGoogle ScholarPubMed
9.Fenwick, E, Claxton, K, Sculpher, M. Representing uncertainty: The role of cost-effectiveness acceptability curves. Health Econ. 2001;10:779–787.CrossRefGoogle ScholarPubMed
10.Fenwick, E, O'Brien, BJ, Briggs, A. Cost-effectiveness acceptability curves–facts, fallacies and frequently asked questions. Health Econ. 2004;13:405–415.CrossRefGoogle ScholarPubMed
11.Giddings, E. The history of thyroidectomy. J R Soc Med. 1998;91 (Suppl 33):3–6.CrossRefGoogle ScholarPubMed
12.Hallgrimsson, P, Lovén, L, Westerdahl, AB. Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: A prospective randomised controlled trial. Langenbecks Arch Surg. 2008;393:675–680.CrossRefGoogle ScholarPubMed
13.Karvounaris, DC, Antonopoluos, V, Psarras, K, Sakadamis, A. Efficacy and safety of ultrasonically activated shears in thyroid surgery. Head Neck. 2006;28:1028–1031.CrossRefGoogle ScholarPubMed
14.Kilic, M, Keskek, M, Ertan, T, et al.A prospective randomized trial comparing the harmonic scalpel with conventional knot tying I thyroidectomy. Adv Ther. 2007;24:632–638.CrossRefGoogle ScholarPubMed
15.Lombardi, CP, Raffaelli, M, Cicchetti, A, et al.The use of “harmonic scalpel” versus “knot tying” for conventional “open” thyroidectomy: Results of a prospective randomized study. Langenbecks Arch Surg. 2008;393:627–631.CrossRefGoogle Scholar
16.McMillan, C, Bradley, C, Razvi, S, Weaver, J.Psychometric evaluation of a new questionnaire measuring treatment satisfaction in Hypothyroidism: The ThyTSQ. Value Health. 2006;9:132–139.CrossRefGoogle ScholarPubMed
17.Meurisse, M, Degechereux, T, Maweja, S, Degauque, C, Vandelaer, M, Hamoir, E. Evaluation of the ultracision ultrasonic dissector in thyroid surgery. Prospective randomized study. Ann Chir. 2000;125:468–472.CrossRefGoogle ScholarPubMed
18.Miccoli, P, Berti, P, Dionisi, G, et al.Randomized controlled trial of harmonic scalpel use during thyroidectomy. Arch Otolaryngol Head Neck Surg. 2006;132:1069–1073.CrossRefGoogle ScholarPubMed
19.Miccoli, P, Berti, P, Raffaelli, M, et al.Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: A prospective randomized study. Surgery. 2001;130:1039–1043.CrossRefGoogle ScholarPubMed
20.Ortega, J, Sala, C, Flor, B, Lledo, S. Efficacy and cost-effectiveness of the Ultracision® harmonic scalpel in thyroid surgery: An analysis of 200 cases in a randomized trial. J Laparoendosc Adv Surg Tech A. 2004;14:9–12.CrossRefGoogle ScholarPubMed
21.Randolph, GW. History of thyroid and parathyroid surgery. In: Donley, S, ed. Surgery of the thyroid and parathyoid glands. Philadelphia, PA: Saunders; 2003:3–11.Google Scholar
22.Shemen, L. Thyroidectomy using the harmonic scalpel: Analysis of 105 consecutive cases. Otolaryngol Head Neck Surg. 2002;127:284–288.CrossRefGoogle ScholarPubMed
23.Siperstein, A, Berber, E, Morkoyun, E. The use of the harmonic scalpel vs conventional knot tying for vessel litigation in thyroid surgery. Arch Surg. 2002;137:137–142.CrossRefGoogle Scholar
24.Stojadinovic, A, Shaha, AR, Orlikoff, RF, et al.Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg. 2002;236:823–832.CrossRefGoogle ScholarPubMed
25.Viapiano, J, Wards, DS. Operating room utilization: The need for data. Int Anesthesiol Clin. 2002;38:127–140.CrossRefGoogle Scholar
26.Voutilainen, PE, Haglund, CH. Ultrasonically activated shears in thyroidectomies. A randomised trial. Ann Surg. 2000;231:322–328.CrossRefGoogle Scholar
27.Yildirim, O, Umit, T, Ebru, M, et al.Ultrasonic harmonic scalpel in total thyroidectomies. Adv Ther. 2008;25:260–265.CrossRefGoogle ScholarPubMed
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