Abstract
Total Thyroidectomy vs Lobectomy in Patient with Suspicious for Papillary Thyroid Cancer Nodule on Fine-Needle-Aspiration: Cost-Effectiveness Analysis
Journal of the American College of Surgeons, Vol.223(4), pp.S46-S46
10/2016
DOI: 10.1016/j.jamcollsurg.2016.06.115
Abstract
Introduction
Recent American Thyroid Association Guidelines recommend lobectomy for patients with a thyroid nodule suspicious for papillary thyroid cancer (PTC) on fine-needle-aspiration (FNA), to be followed by completion thyroidectomy if surgical pathology identified stages III or IV PTC. In this analysis, we aimed to assess the cost-effectiveness of this protocol in comparison with total thyroidectomy.
Methods
A Markov model cost-utility analysis was performed for a base-case followed for 20 years postoperatively. The base-case was defined as a woman aged 40 years with a single (1.0-cm) thyroid nodule suspicious for PTC on FNA. Cost and probabilities data were retrieved from literature for the year of 2013. Effectiveness was represented by quality-adjusted life-year (QALY).
Results
Total thyroidectomy protocol produced an incremental cost of $2,678.30 and incremental effectiveness of -0.25 QALY as compared with lobectomy protocol (incremental cost-effectiveness ratio [ICER] = $-10,830.05/QALY), with the assumption that there is a 12% chance of having stage III or IV PTC after lobectomy that required completion thyroidectomy. Sensitivity analyses with the assumptions of 50% risk of unilateral recurrent laryngeal nerve injury or hypothyroidism post-lobectomy did not make total thyroidectomy a cost-effective alternative. Total thyroidectomy was only cost-effective if there was a more than 38% chance of identifying stage III or IV PTC on surgical pathology after lobectomy.
Conclusions
Total thyroidectomy is not just cost prohibitive, but is also associated with lower effectiveness compared with lobectomy.
Details
- Title: Subtitle
- Total Thyroidectomy vs Lobectomy in Patient with Suspicious for Papillary Thyroid Cancer Nodule on Fine-Needle-Aspiration: Cost-Effectiveness Analysis
- Creators
- Zaid Al-QurayshiSalem I. NoureldineRalph P. Tufano - Johns Hopkins UniversityEmad Kandil - Tulane University
- Resource Type
- Abstract
- Publication Details
- Journal of the American College of Surgeons, Vol.223(4), pp.S46-S46
- Publisher
- ELSEVIER SCIENCE INC
- DOI
- 10.1016/j.jamcollsurg.2016.06.115
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Language
- English
- Date published
- 10/2016
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984702770402771
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