Tiroidectomía total basada en la evidencia, análisis de impacto presupuestario
Palabras clave:
tiroidectomía, costos y análisis de costo, economía de la salud, medicina basada en evidenciaResumen
Introducción. La tiroidectomía total es el procedimiento quirúrgico más común practicado en el cuello. Existen recomendaciones basadas en la evidencia que pueden causar un impacto en el costo del procedimiento. Dicho impacto no ha sido evaluado en el sistema de salud colombiano.
El objetivo de este estudio fue evaluar el impacto presupuestario de la implementación de las recomendaciones basadas en la evidencia, en tiroidectomía total.
Materiales y métodos. Se obtuvo información institucional del uso de recursos en tiroidectomía total. Se hizo un microcosteo utilizando los precios SOAT 2010 y los precios de insumos a partir de las convocatorias públicas para Colombia disponibles en internet. Los costos se dividieron en honorarios, estancia, hospitalización, insumos quirúrgicos, exámenes de laboratorio y medicamentos. Se calculó el valor total del procedimiento y se diseñó un análisis de impacto presupuestario, comparando la práctica actual y la práctica recomendada según criterios de la medicina basada en la evidencia. Como variables de evaluación se utilizaron: la frecuencia de vaciamiento central, el uso de antibióticos profilácticos y drenaje, la estancia hospitalaria, la solicitud de calcio posquirúrgico y la administración de gluconato de calcio en el posoperatorio.
Resultados. Se incluyeron 55 pacientes para la evaluación del uso de recursos. La aplicación de un modelo de tiroidectomía basado en la evidencia, puede disminuir el valor global del procedimiento de 20 a 35 %, según el seguimiento de las recomendaciones.
Discusión. La aplicación de las recomendaciones de la medicina basada en la evidencia en tiroidectomía total, tiene un impacto presupuestario positivo en el sistema de salud.
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Referencias bibliográficas
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https://doi.org/10.1016/j.amjsurg.2005.01.015
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https://doi.org/10.1245/s10434-010-1137-6
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https://doi.org/10.1001/archsurg.2010.9
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https://doi.org/10.1002/lary.20236
20. Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg. 2008;393:693-8.
https://doi.org/10.1007/s00423-008-0360-0
21. Zuniga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2009;135:1087-91.
https://doi.org/10.1001/archoto.2009.163
22. Orloff LA, Kuppersmith RB. American Thyroid Association's central neck dissection terminology and classification for thyroid cancer consensus statement. Otolaryngol Head Neck Surg. 2010;142:4-5.
https://doi.org/10.1016/j.otohns.2009.11.013
23. Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, et al. Consensus statement on the terminology and classi- fication of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153-8.
https://doi.org/10.1089/thy.2009.0159
24. Instituto Nacional de Cancerologia, Ministerio de la Proteccion Social. Protocolos de manejo del paciente con cancer. Bogota: Legis; 2010.
25. Dedivitis RA, Pfuetzenreiter EG, Jr., Castro MA, Denardin OV. Analysis of safety of short-stay thyroid surgery. Acta Otorhino- laryngol Ital. 2009;29:326-30.
26. Mirnezami R, Sahai A, Symes A, Jeddy T. Day-case and short- stay surgery: The future for thyroidectomy? Int J Clin Pract. 2007;61:1216-22.
https://doi.org/10.1111/j.1742-1241.2006.01234.x
27. Lo GP, Gates R, Gazetas P. Outpatient and short-stay thyroid surgery. Head Neck. 1991;13:97-101.
https://doi.org/10.1002/hed.2880130203
28. McAlister VC. Origins of the Canadian School of Surgery. Can J Surg. 2007;50:357-63.
29. Vallancien G. The European School of Surgery . J Chir (Paris). 2002;139:255.
30. Borst HG. Surgical school--an anachronism? Langenbecks Arch Chir Suppl Kongressbd. 1996;113:723-6.
31. Kulkarni RP, Ituarte PH, Gunderson D, Yeh MW. Clinical pathways improve hospital resource use in endocrine surgery. J Am Coll Surg. 2011;212:35-41.
https://doi.org/10.1016/j.jamcollsurg.2010.09.016
32. D'Hubert E, Proske JM. How to optimize the economic viabi- lity of thyroid surgery in a French public hospital? J Visc Surg. 2010;147:e259-e263.
https://doi.org/10.1016/j.jviscsurg.2010.07.009
33. Ramanujam LN, Cheah WK. Improvements in health care for patients undergoing thyroidectomy. Asian J Surg. 2005;28:266-70.
https://doi.org/10.1016/S1015-9584(09)60358-4
34. Markey DW, McGowan J, Hanks JB. The effect of clinical pathway implementation on total hospital costs for thyroidec- tomy and parathyroidectomy patients. Am Surg. 2000;66:533-8.
35. Garcia M, Mohedano A, Acosta F. Tiroidectomias sin drenajes. Rev Cubana Cir. 2006;45:6.
36. Pitoia F, Ward L, Wohllk N, Friguglietti C, Tomimori E, Gau- na A, et al. Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arq Bras Endocrinol Metabol. 2009;53:884-7.
https://doi.org/10.1590/S0004-27302009000700014
37. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167-214.
https://doi.org/10.1089/thy.2009.0110
38. Hay ID, Thompson GB, Grant CS, Bergstralh EJ, Dvorak CE, Gorman CA, et al. Papillary thyroid carcinoma managed at the
39. Mayo Clinic during six decades (1940-1999): Temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26:879-85.
https://doi.org/10.1007/s00268-002-6612-1
40. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102:1088-95.
41. Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: An analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 2007;205:748-54.
https://doi.org/10.1016/j.jamcollsurg.2007.06.298
42. Snyder SK, Hamid KS, Roberson CR, Rai SS, Bossen AC, Luh JH, et al. Outpatient thyroidectomy is safe and reasonable: Experience with more than 1,000 planned outpatient procedures. J Am Coll Surg. 2010;210:575-4.
https://doi.org/10.1016/j.jamcollsurg.2009.12.037
https://doi.org/10.1136/bmj.312.7023.71
2. Sanabria A, Dominguez LC, Vega V, Osorio C, Duarte D. Rou- tine postoperative administration of vitamin D and calcium after total thyroidectomy: A meta-analysis. Int J Surg. 2011;9:46-51.
https://doi.org/10.1016/j.ijsu.2010.08.006
3. Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis. Laryngoscope. 2011;121:1009-17.
https://doi.org/10.1002/lary.21578
4. Ecker T, Carvalho AL, Choe JH, Walosek G, Preuss KJ. He- mostasis in thyroid surgery: Harmonic scalpel versus other techniques--a meta-analysis. Otolaryngol Head Neck Surg. 2010;143:17-25.
https://doi.org/10.1016/j.otohns.2010.03.018
5. Sanabria A, Carvalho AL, Silver CE, Rinaldo A, Shaha AR, Kowalski LP, et al. Routine drainage after thyroid surgery--a meta-analysis. J Surg Oncol. 2007;96:273-80.
https://doi.org/10.1002/jso.20821
6. Chatterjee A, Payette MJ, Demas CP, Finlayson SR. Opportunity cost: A systematic application to surgery. Surgery. 2009;146:18-22.
https://doi.org/10.1016/j.surg.2009.03.027
7. Palmer S, Raftery J. Economic notes: Opportunity cost. BMJ. 1999;318:1551-2.
https://doi.org/10.1136/bmj.318.7197.1551
8. Robinson R. Cost-effectiveness analysis. BMJ. 1993;307:793-5.
https://doi.org/10.1136/bmj.307.6907.793
9. Walsh K, Rutherford A, Richardson J, Moore P. NICE medical education modules: An analysis of cost-effectiveness. Educ Prim Care. 2010;21:396-8.
10. Marshall DA, Douglas PR, Drummond MF, Torrance GW, Macleod S, Manti O, et al. Guidelines for conducting pharma- ceutical budget impact analyses for submission to public drug plans in Canada. Pharmacoeconomics. 2008;26:477-95.
https://doi.org/10.2165/00019053-200826060-00003
11. Mauskopf JA, Sullivan SD, Annemans L, Caro J, Mullins CD, Nuijten M, et al. Principles of good practice for budget impact analysis: Report of the ISPOR Task Force on good research practices--budget impact analysis. Value Health. 2007;10:336-47.
https://doi.org/10.1111/j.1524-4733.2007.00187.x
12. Trueman P, Drummond M, Hutton J. Developing guidance for budget impact analysis. Pharmacoeconomics. 2001;19:609-21.
https://doi.org/10.2165/00019053-200119060-00001
13. Facultad de Salud, Universidad del Valle. Registro Poblacional de Cáncer de Cali. [serial online] 2011. Fecha de consulta: 20 de noviembre de 2011. Disponible en: http://rpcc.univalle.edu. co/es/index.php.
14. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005;189:395-404.
https://doi.org/10.1016/j.amjsurg.2005.01.015
15. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg. 1993;128:79-88.
https://doi.org/10.1001/archsurg.1993.01420130087014
16. Samraj K, Gurusamy KS. Wound drains following thyroid surgery. Cochrane Database Syst Rev. 2007;CD006099.
https://doi.org/10.1002/14651858.CD006099.pub2
17. Zetoune T, Keutgen X, Buitrago D, Aldailami H, Shao H, Ma- zumdar M, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: A meta-analysis. Ann Surg Oncol. 2010;17:3287-93.
https://doi.org/10.1245/s10434-010-1137-6
18. Shen WT, Ogawa L, Ruan D, Suh I, Kebebew E, Duh QY, et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145:272-5.
https://doi.org/10.1001/archsurg.2010.9
19. Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope. 2009;119:1135-9.
https://doi.org/10.1002/lary.20236
20. Palestini N, Borasi A, Cestino L, Freddi M, Odasso C, Robecchi A. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg. 2008;393:693-8.
https://doi.org/10.1007/s00423-008-0360-0
21. Zuniga S, Sanabria A. Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2009;135:1087-91.
https://doi.org/10.1001/archoto.2009.163
22. Orloff LA, Kuppersmith RB. American Thyroid Association's central neck dissection terminology and classification for thyroid cancer consensus statement. Otolaryngol Head Neck Surg. 2010;142:4-5.
https://doi.org/10.1016/j.otohns.2009.11.013
23. Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, et al. Consensus statement on the terminology and classi- fication of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153-8.
https://doi.org/10.1089/thy.2009.0159
24. Instituto Nacional de Cancerologia, Ministerio de la Proteccion Social. Protocolos de manejo del paciente con cancer. Bogota: Legis; 2010.
25. Dedivitis RA, Pfuetzenreiter EG, Jr., Castro MA, Denardin OV. Analysis of safety of short-stay thyroid surgery. Acta Otorhino- laryngol Ital. 2009;29:326-30.
26. Mirnezami R, Sahai A, Symes A, Jeddy T. Day-case and short- stay surgery: The future for thyroidectomy? Int J Clin Pract. 2007;61:1216-22.
https://doi.org/10.1111/j.1742-1241.2006.01234.x
27. Lo GP, Gates R, Gazetas P. Outpatient and short-stay thyroid surgery. Head Neck. 1991;13:97-101.
https://doi.org/10.1002/hed.2880130203
28. McAlister VC. Origins of the Canadian School of Surgery. Can J Surg. 2007;50:357-63.
29. Vallancien G. The European School of Surgery . J Chir (Paris). 2002;139:255.
30. Borst HG. Surgical school--an anachronism? Langenbecks Arch Chir Suppl Kongressbd. 1996;113:723-6.
31. Kulkarni RP, Ituarte PH, Gunderson D, Yeh MW. Clinical pathways improve hospital resource use in endocrine surgery. J Am Coll Surg. 2011;212:35-41.
https://doi.org/10.1016/j.jamcollsurg.2010.09.016
32. D'Hubert E, Proske JM. How to optimize the economic viabi- lity of thyroid surgery in a French public hospital? J Visc Surg. 2010;147:e259-e263.
https://doi.org/10.1016/j.jviscsurg.2010.07.009
33. Ramanujam LN, Cheah WK. Improvements in health care for patients undergoing thyroidectomy. Asian J Surg. 2005;28:266-70.
https://doi.org/10.1016/S1015-9584(09)60358-4
34. Markey DW, McGowan J, Hanks JB. The effect of clinical pathway implementation on total hospital costs for thyroidec- tomy and parathyroidectomy patients. Am Surg. 2000;66:533-8.
35. Garcia M, Mohedano A, Acosta F. Tiroidectomias sin drenajes. Rev Cubana Cir. 2006;45:6.
36. Pitoia F, Ward L, Wohllk N, Friguglietti C, Tomimori E, Gau- na A, et al. Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arq Bras Endocrinol Metabol. 2009;53:884-7.
https://doi.org/10.1590/S0004-27302009000700014
37. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167-214.
https://doi.org/10.1089/thy.2009.0110
38. Hay ID, Thompson GB, Grant CS, Bergstralh EJ, Dvorak CE, Gorman CA, et al. Papillary thyroid carcinoma managed at the
39. Mayo Clinic during six decades (1940-1999): Temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26:879-85.
https://doi.org/10.1007/s00268-002-6612-1
40. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102:1088-95.
41. Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: An analysis of pooled individual patient data from nine observational studies. J Am Coll Surg. 2007;205:748-54.
https://doi.org/10.1016/j.jamcollsurg.2007.06.298
42. Snyder SK, Hamid KS, Roberson CR, Rai SS, Bossen AC, Luh JH, et al. Outpatient thyroidectomy is safe and reasonable: Experience with more than 1,000 planned outpatient procedures. J Am Coll Surg. 2010;210:575-4.
https://doi.org/10.1016/j.jamcollsurg.2009.12.037
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2012-01-01
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Sanabria, Álvaro; Gómez, X.; Domínguez, L. C.; Vega, V.; Osorio, C. Tiroidectomía Total Basada En La Evidencia, análisis De Impacto Presupuestario. Rev Colomb Cir 2012, 27, 30-39.
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