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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References
- Increasing incidence of thyroid cancer in the United States, 1973-2002.JAMA. 2006; 295: 2164-2167
- The increasing incidence of small thyroid cancers: Where are the cases coming from?.Laryngoscope. 2010; 120: 2446-2451
- 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.Thyroid. 2016; 26: 1-133
- An observational trial for papillary thyroid microcarcinoma in Japanese patients.World J Surg. 2010; 34: 28-35
- Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation.Thyroid. 2014; 24: 27-34
- United States life tables, 2009.Natl Vital Stat Rep. 2014; 62: 1-63
- Extent of surgery affects survival for papillary thyroid cancer.Ann Surg. 2007; 246 (discussion 381-4): 375-381
- A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma.Eur J Endocrinol. 2015; 173: 367-375
- Routine prophylactic central neck dissection for low-risk papillary thyroid cancer: {A} cost-effectiveness analysis.Surg. 2013; 154: 1148-1155
- Cost-effectiveness of molecular testing for thyroid nodules with atypia of undetermined significance cytology.J Clin Endocrinol Metab. 2014; 99: 2674-2682
- CY 2013 medicare physician fee schedule final rule with comment period (CMS-1590-FC) [Internet]. Centers for Medicare & Medicaid Services, Baltimore (MD)2012 (Available from:)
- Hcup Facts and Figures: statistics on hospital-based care in the United States, 2009 [Internet]. Agency for Healthcare Research and Quality (US), Rockville (MD)2011 (Available from:)
- Red Book Online [database online] [Internet]. Truven Health Analytics, Inc, Ann Arbor (MI)2016 (Available from:)
- A decision analysis for treatment of clinically localized prostate cancer.J Gen Intern Med. 1997; 12: 299-305
- The cost-utility of open prostatectomy compared with active surveillance in early localised prostate cancer.BMC Health Serv Res. 2014; 14: 163
- Predicting utility ratings for joint health states from single health states in prostate cancer: empirical testing of 3 alternative theories.Med Decis Mak. 2007; 28: 102-112
- Utilities for prostate cancer health states in men aged 60 and older.Med Care. 2005; 43: 347-355
- Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis.Surgery. 2001; 130: 921-930
- Total thyroidectomy or thyroid lobectomy in patients with low-risk differentiated thyroid cancer: Surgical decision analysis of a controversy using a mathematical model.World J Surg. 2000; 24: 1295-1302
- Cost-effectiveness of using recombinant human thyroid-stimulating hormone before radioiodine ablation for thyroid cancer: the Canadian perspective.Value Health. 2010; 13: 180-187
- Active surveillance for early-stage prostate cancer: review of the current literature.Cancer. 2008; 112: 1650-1659
- Patient utilities for complications do not predict treatment choice in men with clinically localized prostate cancer.J Clin Outcomes Manag. 2001; 8: 17-22
- Updating cost-effectiveness - the curious resilience of the $50,000-per-QALY threshold.N Engl J Med. 2014; 371: 796-797
- Should all papillary thyroid microcarcinomas be aggressively treated?.Ann Surg. 2011; 254: 653-660
Article info
Publication history
Published online: November 10, 2016
Accepted:
June 16,
2016
Identification
Copyright
Published by Elsevier Inc.
