Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer.

Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer.

Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer.

Cost-effectiveness of active surveillance AS versus hemithyroidectomy for micropapillary thyroid cancer.

What about comparing thyroid radiofrequency ablation to AS?

Dr.Guttler’s comments:

  1. At present the patient with a micropapillary cancer of the thyroid is given only 2 options.
  2. Those who do not want surgery are left with long term AS.
  3. Even with just those two options 25% start and drop out of AS for surgery.
  4. If thyroid RFA was given as a third option there would be many more who would not want AS but also did not want invasive surgery.
  5. This study below shows how lobectomy was cost effective.
  6. There is no cost effective study now on thyroid RFA vs AS, but the costs of RFA are less than surgery and has not long term expense in most cases as the tumor is ablated as in the AS follow up regimen.
  7. Therefore the cost effectiveness of thyroid RFA will be even more than that for lobectomy as shown in this study.
  8. I predict that as we move into the age of thyroid RFA treatment, thyroid RFA for thyroid micro-cancer will be the treatment of choice for most patients as it has the advantage of removal of the cancer without surgery, and has the advantage over AS as the tumor is removed without long term fears of an enlarging cancer or lymph node spread and the extra expense of long term ultrasound follow up.
  9. At my center I offer thyroid RFA for micro-papillary thyroid cancer <1.5 cm.
  10. Call me at 310-393-8860 or [email protected]
  11. Ask for Alicia
  12. Dr.G.

Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer

Presented at the annual meeting for the American Association of Endocrine Surgeons, April 10–12, 2016, in Baltimore, MD.

Background

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 of micropapillary thyroid cancer is a viable alternative to hemithyroidectomy. We conducted a cost-effectiveness analysis to help decide between observation versus operation.

Methods

We constructed Markov models for active surveillance and hemithyroidectomy. The reference case was a 40-year-old patient with recently diagnosed, low-risk micropapillary thyroid cancer. Costs and health utilities were determined using extensive literature review. The willingness-to-pay threshold was set at $100,000/quality-adjusted life year gained. Deterministic and probabilistic sensitivity analyses were performed to account for uncertainty in the model’s variables.

Results

Active surveillance is dominant (less expensive and more quality-adjusted life years) for a health utility <0.01 below that for disease-free, posthemithyroidectomy state, or for a remaining life expectancy of <2 years. For a utility difference ≥0.02, the incremental cost-effectiveness ratio (the ratio of the difference in costs between active surveillance and hemithyroidectomy divided by the difference in quality-adjusted life years) for hemithyroidectomy is <$100,000/QALY gained and thus cost-effective. For a utility difference of 0.11—the reference case scenario—the incremental cost-effectiveness ratio for hemithyroidectomy is $4,437/quality-adjusted life year gained.

Conclusion

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.

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