Cost-effectiveness of preoperative parathyroid imaging in primary hyperparathyroidism: A synthesis of eight health-economic analyses.

Authors

Petra Petranović Ovčariček, Matija Romić, Vedrana Gladić Nenadić, Martin W Huellner

Published in

European journal of nuclear medicine and molecular imaging. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Preoperative localisation of hyperfunctioning parathyroid tissue underpins minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). Cervical ultrasound (cUS), [⁹⁹ᵐTc]Tc-sestamibi ([⁹⁹ᵐTc]Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT), and choline positron emission tomography/computed tomography (PET/CT) differ in diagnostic accuracy and cost. Whether choline PET/CT should be reserved for second-line use or implemented first-line remains debated. We synthesised cost-effectiveness evidence from recent health-economic analyses across different healthcare systems.
In this narrative review, MEDLINE (via PubMed) was searched for original health-economic analyses evaluating preoperative parathyroid imaging in pHPT published 2022-2026, supplemented by reference-list screening. Eight studies were included. The modelling framework, analytical perspective, imaging comparators, base-case costs, incremental cost-effectiveness ratios (ICERs), incremental cost-utility ratios (ICURs) and willingness-to-pay (WTP) thresholds were extracted.
The included studies comprised two retrospective cohorts, three decision trees, one Markov model, one cohort-level state-transition model, and one randomised controlled trial (APACH2). Across most healthcare settings, first-line choline PET/CT was more cost-effective than [⁹⁹ᵐTc]Tc-MIBI-based pathways. Reported ICERs included €471 per additional surgical cure (APACH2), US$470 per quality-adjusted life-year (QALY) (USA), €12,650 per QALY (France), and Colombian pesos (COP) 101,727-277,037 per additional cure. At one Dutch centre, [¹¹C]choline PET/CT was a dominant strategy (ICUR -€18,846/QALY), while a Spanish cohort demonstrated approximately 19% lower per-patient costs with PET-only imaging. PET tariff and local [⁹⁹ᵐTc]Tc-MIBI performance were the principal determinants of cost-effectiveness.
First-line choline PET/CT is cost-effective compared with [⁹⁹ᵐTc]Tc-MIBI-based imaging pathways across most WTP thresholds. Implementation should be guided by local PET reimbursement and [⁹⁹ᵐTc]Tc-MIBI performance.

PMID:
42566021
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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