{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:32:10Z","timestamp":1789421530189,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Primary hyperparathyroidism (PHPT) is a common endocrine disorder, most often caused by a single parathyroid adenoma, for which parathyroidectomy is the treatment of choice. Accurate preoperative localization is essential for focused surgery. In Colombia, technetium\u201099\u2009m sestamibi SPECT\/CT (MIBI\u2010SPECT\/CT) is the standard, though limited by low sensitivity. 18F\u2010choline PET\/CT offers superior accuracy but at a higher cost. The only randomized trial comparing both modalities is the APACH2 study (Quak et\u00a0al.).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a cost\u2010effectiveness study using three decision\u2010analytic models, incorporating Colombian healthcare costs, diagnostic accuracy, and surgical outcomes based on APACH2 data. One was deterministic, while two used probabilistic approaches: one directly from trial results and another adapted to local clinical practice. Decision trees assumed that imaging strategies lead to different costs and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all models, upfront PET\/CT was more costly but also more effective than MIBI\u2010SPECT\/CT, with an incremental cost\u2010effectiveness ratio below Colombia's willingness\u2010to\u2010pay (WTP) threshold. Sensitivity analyses identified normocalcemia probability, test sensitivity, and imaging cost as main drivers. In probabilistic and adapted models, PET\/CT remained cost\u2010effective, exceeding 99% probability when WTP surpassed COP 4\u2009000\u2009000 per additional cured patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>18F\u2010choline PET\/CT is a clinically useful and cost\u2010effective strategy for preoperative localization in PHPT compared with MIBI\u2010SPECT\/CT. These findings support its selective adoption in diagnostic algorithms and inform healthcare policy decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70204","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T13:26:20Z","timestamp":1772976380000},"page":"1841-1850","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost\u2010Effectiveness of\n                    <scp>18F<\/scp>\n                    \u2010Choline\n                    <scp>PET<\/scp>\n                    \/\n                    <scp>CT<\/scp>\n                    Versus\n                    <scp>MIBI SPECT<\/scp>\n                    \/\n                    <scp>CT<\/scp>\n                    for Preoperative Localization in Primary Hyperparathyroidism in the Colombian Healthcare System"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2858-0118","authenticated-orcid":false,"given":"Figueroa\u2010Boh\u00f3rquez","family":"David","sequence":"first","affiliation":[{"name":"Department of Surgery, Head and Neck Surgery, School of Medicine Universidad de Antioquia  Medellin Colombia"},{"name":"CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mendieta","family":"Laura","sequence":"additional","affiliation":[{"name":"Department of Surgery, Head and Neck Surgery, School of Medicine Universidad de Antioquia  Medellin Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5563-8840","authenticated-orcid":false,"given":"Sanabria","family":"Alvaro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Head and Neck Surgery, School of Medicine Universidad de Antioquia  Medellin Colombia"},{"name":"CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1106636"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4137\/CMED.S13147"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010009\u20100773\u20101"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010016\u20105694\u20101"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2021.0915"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259\u2010024\u201006771\u20101"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.03.075"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102023\u2010082901"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2478\/raon\u20102024\u20100058"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41824\u2010025\u201000244\u2010w"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014\u20101413"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.1421"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14155468"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010025\u201003824\u20103"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010016\u20101425\u20100"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2019.0574"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.23736\/S1824\u20104785.23.03512\u20104"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2014.965255"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1017"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad073"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259\u2010023\u201006537\u20101"}],"container-title":["Head &amp; 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