The Value of Intraoperative Parathyroid Hormone Monitoring in Localized Primary Hyperparathyroidism: A Cost Analysis

Minimally invasive parathyroidectomy (MIP) is the preferred approach to primary hyperparathyroidism (PHPT) when a single adenoma can be localized preoperatively. The added value of intraoperative parathyroid hormone (IOPTH) monitoring remains debated because its ability to prevent failed parathyroidectomy due to unrecognized multiple gland disease (MGD) must be balanced against assay-related costs. We used a decision tree and cost analysis model to examine IOPTH monitoring in localized PHPT. Literature review identified 17 studies involving 4,280 unique patients, permitting estimation of base case costs and probabilities. Sensitivity analyses were performed to evaluate the uncertainty of the assumptions associated with IOPTH monitoring and surgical outcomes. IOPTH cost, MGD rate, and reoperation cost were varied to evaluate potential cost savings from IOPTH. The base case assumption was that in well-localized PHPT, IOPTH monitoring would increase the success rate of MIP from 96.3 to 98.8%. The cost of IOPTH varied with operating room time used. IOPTH reduced overall treatment costs only when total assay-related costs fell below $110 per case. Inaccurate localization and high reoperation cost both independently increased the value of IOPTH monitoring. The IOPTH strategy was cost saving when the rate of unrecognized MGD exceeded 6$12,000 (compared with initial MIP cost of $3733). Setting the positive predictive value of IOPTH at 100% and reducing the false-negative rate to 0% did not substantially alter these findings. Institution-specific factors influence the value of IOPTH. In this model, IOPTH increased the cure rate marginally while incurring approximately 4% additional cost

Miradas y voces de la Investigación Educativa III : Formación y desarrollo profesional docente. Innovación Educativa con miras a la justicia social. Aportes desde la Investigación Educativa

Fil: Ferreyra, Horacio Ademar. Universidad Católica de Córdoba. Facultad de Educación; ArgentinaFil: Sañudo Guerra, Lya. Universidad Católica de Córdoba. Facultad de Educación; Argentin

The flexibility of bridging phosphinoyl ligands: new classes of triplatinum(II) and diplatinum(I) complexes.

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The neuroeconomic path of the law.

Advances in evolutionary biology, experimental economics and neuroscience are shedding new light on age-old questions about right and wrong, justice, freedom, the rule of law and the relationship between the individual and the state. Evidence is beginning to accumulate suggesting that humans evolved certain fundamental behavioural predispositions grounded in our intense social natures, that those predispositions are encoded in our brains as a distribution of probable behaviours, and therefore that there may be a core of universal human law

The economic costs of invasive aquatic plants: a global perspective on ecology and management gaps

International audienc

Benefits do not balance costs of biological invasions

Biological invasions have profound impacts on biodiversity and ecosystem functioning and services, resulting in substantial economic and health costs estimated in the trillions of dollars. Preventing and managing biological invasions are vital for sustainable development, aligning with the goals of the United Nations Biodiversity Conference. However, some invasive species also offer occasional benefits, leading to divergent perceptions among stakeholders and sectors. Claims that invasion science overlooks positive contributions threaten to hinder proper impact assessment and undermine management. Quantitatively balancing benefits and costs is misleading, because they coexist without offsetting each other. Any benefits also come at a price, affecting communities and regions differently over time. An integrated approach considering both costs and benefits is necessary for understanding and effective management of biological invasions