The management of low-risk micropapillary thyroid cancer <1 cm in size has come into question, because recent data have shown that nonoperative active surveillance AS of micropapillary thyroid cancer is a viable alternative to hemithyroidectomy. We conducted a cost-effectiveness analysis to help decide between observation versus operation.
The reference case was a 40-year-old patient with recently diagnosed, low-risk micropapillary thyroid cancer.
Active surveillance is dominant (less expensive and more quality-adjusted life years).
The cost-effectiveness of hemithyroidectomy is highly dependent on patient disutility associated with active surveillance. In patients who would associate nonoperative management with at least a modest decrement in quality of life, hemithyroidectomy is cost-effective.
Comment: The modest chance of a modest decrease quality of life with AS compared to lobectomy may make lobectomy appealing to some and with those cases the surgery would be cost effective. However, the whole idea of AS is not to have surgery at all except to those with enlarging micro-cancer of 3 mm. These few would need surgery at a later date.They have effects from waiting until it may grow.
US of 2 small micro-papillary ideal for AS over surgery.