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

Abstract：

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.

journal_name

Surgery

journal_title

Surgery

authors

Venkatesh S,Pasternak JD,Beninato T,Drake FT,Kluijfhout WP,Liu C,Gosnell JE,Shen WT,Clark OH,Duh QY,Suh I

doi

10.1016/j.surg.2016.06.076

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

116-126

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(16)30570-0

journal_volume

161

pub_type

杂志文章

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