Abstract
Background
An ongoing debate exists over the optimal management of low-risk papillary thyroid
cancer. The American Thyroid Association supports the concept of active surveillance
to manage low-risk papillary thyroid cancer; however, the cost-effectiveness of active
surveillance has not yet been established. We sought to perform a cost-effectiveness
analysis comparing active surveillance versus surgical intervention for patients in
the United States.
Methods
A Markov decision tree model was developed to compare active surveillance and thyroid
lobectomy. Our reference case is a 40-year-old female who was diagnosed with unifocal
(<15 mm), low-risk papillary thyroid cancer. Probabilistic outcomes, costs, and health
utilities were determined using an extensive literature review. The willingness-to-pay
threshold was set at $50,000/quality-adjusted life year gained. Sensitivity analyses
were performed to account for uncertainty in the model's variables.
Results
Lobectomy provided a final effectiveness of 21.7/quality-adjusted life years, compared
with 17.3/quality-adjusted life years for active surveillance. Furthermore, incremental
cost effectiveness ratio for lobectomy versus active surveillance was $19,560/quality-adjusted
life year (<willing-to-pay threshold of $50,000/quality-adjusted life year), and thus
surgical intervention proved to be cost-effective in patients between 40 and 69 years
old. Further analysis revealed that, at the age of 69 years, active surveillance is
more cost-effective than lobectomy, with a final effectiveness of 17.3/quality-adjusted
life years. Compared to active surveillance, the incremental cost effectiveness ratio
for lobectomy at the age of 69 was $27,235/quality-adjusted life year, which decreases
quality-adjusted life years by 1.5.
Conclusion
Lobectomy is a cost-effective strategy in middle-aged patients with low-risk papillary
thyroid cancer. In contrast, active surveillance is cost-effective beginning at the
age of 69. Identification of such nuances can help physicians and patients determine
the best, most individualized long-term management strategy for low-risk papillary
thyroid cancer.
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Article info
Publication history
Published online: August 10, 2021
Accepted:
May 15,
2021
Identification
Copyright
Published by Elsevier Inc.
