{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T02:26:36Z","timestamp":1769999196537,"version":"3.49.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T00:00:00Z","timestamp":1499990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intraoperative nerve monitoring (IONM) provides dynamic neural information and is recommended for high-risk thyroid surgery. In this analysis, the cost-effectiveness of IONM in preventing bilateral recurrent laryngeal nerve (RLN) injury was investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov chain model was constructed based on IONM use. The base-case patient was defined as a 40-year-old woman presenting with a 4\u00b71-cm left-sided papillary thyroid cancer who developed RLN injury with loss of monitoring signal during planned bilateral thyroidectomy. It was hypothesized that, if the surgeon had used IONM, the RLN injury would have been detected and the operation would have been concluded as a thyroid lobectomy to avoid the risk of contralateral RLN injury. Cost in US dollars was converted to euros; probabilities and utility scores were identified from the literature and government resources. Length of follow-up was set as 20 years, and willingness-to-pay (WTP) as \u20ac38 000 (US $50 000) per quality-adjusted life-year (QALY).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At the end of year 20, the not using IONM strategy accrued \u20ac163 995\u00b740 (US $215 783\u00b743) and an effectiveness of 14\u00b715 QALYs, whereas use of the IONM strategy accrued \u20ac170 283\u00b768 (US $224 057\u00b748) and an effectiveness of 14\u00b733 QALYs. The incremental cost\u2013effectiveness ratio, comparing use versus no use of IONM, was \u20ac35 285\u00b726 (US $46 427\u00b797) per QALY, which is below the proposed WTP, indicating that IONM is the preferred and cost-effective management plan. A Monte Carlo simulation test that considered variability of the main study factors in a hypothetical sample of 10 000 patients showed IONM to be the preferred strategy in 85\u00b78 per cent of the population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Use of IONM is cost-effective in patients undergoing bilateral thyroid surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bjs.10582","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T10:52:44Z","timestamp":1500029564000},"page":"1523-1531","source":"Crossref","is-referenced-by-count":55,"title":["Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy"],"prefix":"10.1093","volume":"104","author":[{"given":"Z","family":"Al-Qurayshi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Iowa Hospitals and Clinics, 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