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Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro\u2010scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high\u2010volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low\u2010volume setting (1 procedure per week). Energy\u2010based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about \u20ac2,600.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: \u20ac3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from \u20ac3,713 to \u20ac3,770 (scenarios 2 and 3), 5\u20137% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (\u20ac3,969).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5\u20137% of the hospitalization costs for a thyroidectomy.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-012-1452-0","type":"journal-article","created":{"date-parts":[[2012,2,1]],"date-time":"2012-02-01T17:02:51Z","timestamp":1328115771000},"page":"748-754","source":"Crossref","is-referenced-by-count":51,"title":["Visualization versus Neuromonitoring of Recurrent Laryngeal Nerves during Thyroidectomy: What About the Costs?"],"prefix":"10.1002","volume":"36","author":[{"given":"Gianlorenzo","family":"Dionigi","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Endocrine Surgery Research Center University of Insubria Varese\u2010Como Via Guicciardini 21100 Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bacuzzi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University of Insubria 21100 Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Boni","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Endocrine Surgery Research Center University of Insubria Varese\u2010Como Via Guicciardini 21100 Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Rausei","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Endocrine Surgery Research Center University of Insubria Varese\u2010Como Via Guicciardini 21100 Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Rovera","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Endocrine Surgery Research Center University of Insubria Varese\u2010Como Via Guicciardini 21100 Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzo","family":"Dionigi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Endocrine Surgery Research Center University of Insubria Varese\u2010Como Via Guicciardini 21100 Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,2,2]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-008-9483-2"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6417"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2007.02.011"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010008\u20109724\u20104"},{"key":"e_1_2_6_6_2","first-page":"451","article-title":"Intraoperative monitoring of the recurrent laryngeal nerve. 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