{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:27:25Z","timestamp":1786944445475,"version":"build-2736575974"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative hypoparathyroidism is the most common complication after total thyroidectomy, and is associated with impaired quality of life and increased long-term healthcare use. Indocyanine green fluorescence imaging enables real-time intraoperative assessment of parathyroid perfusion, potentially improving gland preservation. However, its cost-effectiveness in routine surgical practice has not been formally evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A model-based cost-effectiveness analysis was conducted comparing angiography-guided thyroidectomy with conventional thyroidectomy from the perspective of the Spanish National Health System. A state-transition Markov model simulated long-term outcomes for adults undergoing thyroidectomy, incorporating the incidence of transient and permanent hypoparathyroidism, health-related quality-adjusted life-years, and direct medical costs. The model used contemporary surgical data, included a 35-year time horizon, and discounted costs and effects at 3.5% annually. Probabilistic and deterministic sensitivity analyses were used to assess parameter and structural uncertainty. Cost-effectiveness was judged at a willingness-to-pay threshold of \u20ac30 000 per quality-adjusted life-year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Angiography-guided thyroidectomy was associated with lower lifetime healthcare costs (\u20ac563.7 million versus \u20ac613.2 million) and greater health benefits (310 997 versus 299 107 quality-adjusted life-years), yielding a gain of 11 889 quality-adjusted life-years and \u20ac49.5 million in cost savings. Angiography-guided thyroidectomy dominated conventional thyroidectomy in all sensitivity analyses, with an incremental net monetary benefit of \u20ac406.2 million (95% uncertainty interval \u20ac381.7 million to \u20ac431.5 million). Scenario and joint probabilistic analyses confirmed robustness under alternative utility values and surgical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Angiography-guided thyroidectomy may be a cost-saving innovation within publicly funded healthcare systems by reducing the incidence and chronic burden of postoperative hypoparathyroidism. These findings support broader adoption of fluorescence-guided surgery and underscore the need for real-world implementation studies to validate cost-effectiveness, and inform training and procurement strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag095","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T20:43:09Z","timestamp":1784752989000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of angiography-guided thyroidectomy to prevent postoperative hypoparathyroidism: Spanish National Health System model-based analysis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0718-2797","authenticated-orcid":false,"given":"Pablo","family":"Moreno-Llorente","sequence":"first","affiliation":[{"name":"Unidad de Cirug\u00eda Endocrina, Hospital Universitari de Bellvitge , L\u2019Hospitalet de Llobregat, Barcelona ,","place":["Spain"]},{"name":"Departament de Ci\u00e8ncies Cl\u00edniques, Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Unidad de Cirug\u00eda Endocrina, Hospital Universitari de Bellvitge , L\u2019Hospitalet de Llobregat, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3376-1143","authenticated-orcid":false,"given":"Arantxa","family":"Garc\u00eda-Barrasa","sequence":"additional","affiliation":[{"name":"Unidad de Cirug\u00eda Endocrina, Hospital Universitari de Bellvitge , L\u2019Hospitalet de Llobregat, Barcelona 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Department, Fundaci\u00f3 de Recerca Sant Joan de D\u00e9u , Esplugues de Llobregat, Barcelona ,","place":["Spain"]},{"name":"Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona , L'Hospitalet de Llobregat ,","place":["Spain"]},{"name":"Neuropharmacology and Pain Group, Neuroscience Program, Bellvitge Biomedical Research Institute , L\u2019Hospitalet de Llobregat, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-1379","authenticated-orcid":false,"given":"Sebasti\u00e1n","family":"Videla","sequence":"additional","affiliation":[{"name":"Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona , L'Hospitalet de Llobregat ,","place":["Spain"]},{"name":"Neuropharmacology and Pain Group, Neuroscience Program, Bellvitge Biomedical Research Institute , L\u2019Hospitalet de Llobregat, Barcelona ,","place":["Spain"]},{"name":"Clinical Research Support Area, Germans Tries I Pujol University Hospital , Badalona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026081701214782800_zrag095-B1","doi-asserted-by":"crossref","first-page":"1330524","DOI":"10.3389\/fendo.2024.1330524","article-title":"Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution","volume":"15","author":"Abood","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026081701214782800_zrag095-B2","doi-asserted-by":"crossref","first-page":"S69","DOI":"10.21037\/gs.2017.09.14","article-title":"Hypocalcaemia and permanent hypoparathyroidism after total\/bilateral thyroidectomy in the BAETS 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