ImportanceDelayed autotransplantation of cryopreserved parathyroid tissue (DACP) is the only surgical treatment for permanent postoperative hypoparathyroidism. Studies suggest that only a small minority of cryopreserved samples are ultimately autotransplanted with highly variable outcomes. For these reasons, many have questioned the economic utility of the process, although, to the authors’ knowledge, this has never been formally studied.ObjectiveTo report the clinical outcomes of parathyroid cryopreservation and DACP at a large academic institution and to determine the cost-effectiveness of this treatment.Design, Setting, and ParticipantsAn institutional review board–approved, retrospective review of patients at a single institution who underwent DACP over a 17-year period was conducted with a median follow-up of 48.2 months. A forward-looking cost-utility analysis was then performed to determine the economic utility of cryopreservation/DACP vs usual care (monitoring and supplementation). Patients who had parathyroid tissue in cryopreserved storage between August 2005 to September 2022 at a single-center, academic, quaternary care center were identified.ExposureParathyroid cryopreservation and DACP.Main Outcomes and MeasuresGraft functionality, clinical outcomes, and cost utility using a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY).ResultsA total of 591 patients underwent cryopreservation. Of these, 10 patients (1.7%; mean [SD] age, 45.6 [17.9] years; 6 male [60%]) underwent DACP. A minority of autografts (2 [20%]) were subsequently fully functional, one-half (5 [50%]) were partially functional, and 3 (30%) were not functional. The cost-utility model estimated that at a large academic center over 10 years, the additional cost of 591 patients undergoing cryopreservation and 10 patients undergoing autotransplantation would be $618 791.64 (2022 dollars) and would add 8.75 QALYs, resulting in a cost per marginal QALY of $70 719.04, which is less than the common willingness-to-pay threshold of $100 000/QALY.Conclusions and RelevanceThe reimplantation rate of cryopreserved tissue was low (<2%), but when implanted, autografts were at least partially functional 70% of the time. In the first-ever, to the authors’ knowledge, formal cost analysis for this treatment, results of the current model suggest that cryopreservation and autotransplantation were cost-effective compared with the usual care for hypoparathyroidism at a large, academic institution. It is recommended that each surgical center consider whether the economic and logistical commitments necessary for cryopreservation are worthwhile for their individual needs.

中文翻译：

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甲状旁腺冷冻保存和自体移植的成本效益

重要性冷冻保存的甲状旁腺组织（DACP）的延迟自体移植是永久性术后甲状旁腺功能减退症的唯一手术治疗方法。研究表明，只有一小部分冷冻保存的样本最终能够进行自体移植，结果差异很大。由于这些原因，许多人质疑该过程的经济效用，尽管据作者所知，这从未经过正式研究。目的报告大型学术机构甲状旁腺冷冻保存和 DACP 的临床结果，并确定成本。设计、环境和参与者机构审查委员会批准，对单个机构在 17 年期间接受 DACP 的患者进行了回顾性审查，中位随访时间为 48.2 个月。然后进行前瞻性成本效用分析，以确定冷冻保存/DACP 与常规护理（监测和补充）的经济效用。确定了 2005 年 8 月至 2022 年 9 月期间在单中心、学术、四级护理中心冷冻保存甲状旁腺组织的患者。暴露甲状旁腺冷冻保存和 DACP。主要结果和措施移植物功能、临床结果和成本效用使用意愿-每个质量调整生命年 (QALY) 的支付门槛为 100 000 美元。 结果 共有 591 名患者接受了冷冻保存。其中，10 名患者（1.7%；平均 [SD] 年龄，45.6 [17.9] 岁；6 名男性 [60%]）接受了 DACP。少数自体移植物 (2 [20%]) 随后具有完全功能，一半 (5 [50%]) 具有部分功能，3 个 (30%) 没有功能。成本效用模型估计，在一个大型学术中心 10 年内，591 名接受冷冻保存的患者和 10 名接受自体移植的患者的额外费用将为 618 791.64 美元（2022 年美元），并将增加 8.75 QALY，从而导致每边际 QALY 的成本70 719.04 美元，低于常见的支付意愿阈值 100 000 美元/QALY。结论和相关性冷冻保存组织的再植入率较低（<2%），但在植入时，自体移植物至少部分被植入70% 的时间都能正常工作。据作者所知，对这种治疗的首次正式成本分析表明，当前模型的结果表明，与大型学术机构中甲状旁腺功能减退症的常规护理相比，冷冻保存和自体移植具有成本效益。建议每个手术中心考虑冷冻保存所需的经济和后勤承诺是否值得满足其个人需求。