Cost-effectiveness of intraoperative neural monitoring in thyroid surgery: comment on “Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery”

I read with interest the article by Wang and colleagues “Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery”, published in the International Journal of Surgery (1). The authors analyzed the cost-effectiveness of intraoperative neural monitoring (IONM) in thyroidectomy using a Markov decision model. They concluded that IONM is cost-effective when the rates of recurrent laryngeal nerve (RLN) palsy reach 38.5% (1). This is almost impossible in a clinical setting, implying that IONM is not currently cost-effective.