(006) Diagnostic Timelines and Costs of Telemedicine Evaluation of Thyroid and Parathyroid Disease

Introduction: Thyroid nodules and parathyroid disorders make up a large proportion of otolaryngology and endocrine surgery consultations. Endocrine care is increasingly virtual since the COVID-19 pandemic, but the impact of telehealth on diagnostic timelines and costs for parathyroid and thyroid conditions remains uncertain.

Methods: A retrospective cohort study was conducted using the IBM Marketscan databases from 2018 to 2023. Adults aged 18 to 64 with thyroid or parathyroid disease who had telemedicine evaluation were included. Telemedicine visits were determined based on modifiers and place of service codes. Diagnostic imaging and biopsy dates were captured using ICD-10 and CPT codes. The primary outcome was time to definitive diagnosis. Secondary outcomes included healthcare utilization and total healthcare costs.

Results: Among 447,565 telemedicine thyroid or parathyroid-related visits, 84.6% of patients were female and mean age was 46.6. Nearly 50% of virtual visits occurred for patients in the South. Compared with historically reported in-person diagnostic timelines that average 60-100 days for thyroid disease and over 150 days for hyperparathyroidism, our study found that telemedicine users demonstrated a median time to definitive diagnosis of 104 days (28-239). There was a median of 3 claims during related follow-up care. Median total healthcare costs were $382 (IQR, $237 - $678).

Conclusions: Based on the national cohort from Marketscan, virtual evaluations of thyroid and parathyroid disease were associated with safe, clinically acceptable diagnostic workups and overall stable healthcare usage and costs. The results show that telemedicine is a practical method for endocrine otolaryngology care.