{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:01:04Z","timestamp":1781143264757,"version":"3.54.1"},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"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":["The Laryngoscope"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the cost\u2013utility of major intraoperative neuromonitoring (IONM) strategies in thyroidectomy across commercial platforms, and to quantify the impact of continuous IONM (CIONM), automated nerve trend monitoring, postoperative laryngoscopy policy, and technical failure on total episode costs and medicolegal burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision\u2010analytic cost\u2013utility model of 6000 thyroidectomies was developed using full pathway micro\u2010costing and QALY outcomes. Strategies included visual identification, intermittent IONM, CIONM, needle\u2010based IONM, and automated EMG trend monitoring, evaluated in low\u2010 and high\u2010utilization settings and stratified by manufacturer. The model incorporated RLN injury costs, routine versus EMG\u2010guided selective laryngoscopy, and modality\u2010specific technical failure rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher neuromonitoring utilization substantially reduced monitoring costs (\u20ac420 to \u20ac260 per case), with routine CIONM achieving the lowest values (~\u20ac240). Intermittent IONM and CIONM lowered permanent\/transient RLN palsy rates from 2.0%\/6.0% (visual identification) to 1.2%\/4.0% and 0.8%\/3.0%, reducing RLN\u2010related costs from \u20ac650 to \u20ac430 and \u20ac310 per case. Total per\u2010case costs were \u20ac4400 (no monitoring), \u20ac4250 (intermittent), and \u20ac4100 (CIONM), with CIONM remaining cost\u2010effective (ICER \u2248\u20ac8000). Selective EMG\u2010guided laryngoscopy reduced laryngoscopy costs by up to 65% and improved ICERs. Technical failures increased costs by \u20ac90\u2013\u20ac110 per case but were mitigable. Manufacturer analyses showed similar per\u2010case costs (\u20ac250\u2013\u20ac310) in high\u2010utilization settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Routine CIONM in high\u2010volume centres is the most economically favorable strategy, yielding substantial savings and ICERs within accepted thresholds. Selective EMG\u2010guided laryngoscopy and minimizing technical failures further enhance cost\u2013utility. Automated trend\u2010monitoring platforms offer a pragmatic, near\u2010equivalent alternative where full CIONM deployment is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>5.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70536","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T03:46:02Z","timestamp":1775015162000},"page":"3271-3283","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Value\u2010Based Neuromonitoring in Thyroidectomy: A Comprehensive Cost\u2013Utility Analysis"],"prefix":"10.1002","volume":"136","author":[{"given":"Daqi","family":"Zhang","sequence":"first","affiliation":[{"name":"Division of Thyroid Surgery China\u2010Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma  Changchun Jilin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3191-4369","authenticated-orcid":false,"given":"Francesco","family":"Brucchi","sequence":"additional","affiliation":[{"name":"Division of General Surgery Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano  Milan Italy"},{"name":"Department of Pathophysiology and Transplantation University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation University of Milan  Milan Italy"},{"name":"Division of Endocrinology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cirocchi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, S. 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