• Gabriel Mattucci Domingues Pereira, Matheus Liao, Sergio Samir Arap, Felipe Ferraz Magnabosco, Marilia D'Elboux Guimarães Brescia, Rosa Maria Affonso Moyses, Melani Ribeiro Custódio, Vanda Jorgetti, Luiz Paulo Kowalski, and Fábio Luiz de Menezes Montenegro.
• Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: gabriel.mattucci@fm.usp.br.
• Clinics (Sao Paulo). 2024 Jan 1; 79: 100484100484.

IntroductionSubtotal Parathyroidectomy (S-PTx) and total Parathyroidectomy with immediate Autograft (PTx-AG) are well-established techniques for the treatment of refractory Secondary Hyperparathyroidism (SHPT), with comparable improvements in patients' quality of life and survival. However, the long-term costs after these operations may impact the choice of surgical technique. The objective of the study is to analyze the impact of surgical treatment on medication costs and whether there is any difference between medication use after each procedure, considering impacts on the health system.Material And MethodsProspective and randomized study in patients with severe SHPT undergoing S-PTx and PTx-AG. Analysis of prescribed medication costs in the month before the postoperative period at 1-, 3-, 6-, 12-, and 18 months. Costs were estimated according to government payment system values. The medications of 65 patients after PTx-AG were compared with those of 24 patients after S-PTx. A comparison of the total costs of the period between 38 men and 51 women was also made.ResultsThere were 89 evaluable cases. Surgery reduced medication costs after 12 months. The median of total drug costs in the analyzed period was R$ 8,375.00 per patient. There was no difference in costs per patient in the S-PTx group compared to the PTx-AG group. The median total costs were R$ 11,063.0 for men and R$ 7,651.0 for women (p = 0.0078).ConclusionsThe type of parathyroidectomy did not impact costs after surgery. In the first year after surgery, the use of calcium and calcitriol was more significant than the use of other medications. In the following months, the use of sevelamer is responsible for the highest costs. Men have higher costs in outpatient follow-up after surgery.Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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