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Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer.
- Author(s): Venkatesh, Shriya;
- Pasternak, Jesse D;
- Beninato, Toni;
- Drake, Frederick T;
- Kluijfhout, Wouter P;
- Liu, Chienying;
- Gosnell, Jessica E;
- Shen, Wen T;
- Clark, Orlo H;
- Duh, Quan-Yang;
- Suh, Insoo
- et al.
Published Web Locationhttp://ac.els-cdn.com/S0039606016305700/1-s2.0-S0039606016305700-main.pdf?_tid=ffaeeb44-f561-11e6-9803-00000aab0f01&acdnat=1487371373_c569abf177873685ae2bf43b951ff6b9
No data is associated with this publication.
BackgroundThe 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.
MethodsWe 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.
ResultsActive 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.
ConclusionThe 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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