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

  • Author(s): Venkatesh, S
  • Pasternak, JD
  • Beninato, T
  • Drake, FT
  • Kluijfhout, WP
  • Liu, C
  • Gosnell, JE
  • Shen, WT
  • Clark, OH
  • Duh, QY
  • Suh, I
  • et al.
Abstract

© 2016 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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