Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer.
Surgery
; 161(1): 116-126, 2017 01.
Article
em En
| MEDLINE
| ID: mdl-27839930
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.
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Tireoidectomia
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Neoplasias da Glândula Tireoide
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Carcinoma
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Análise Custo-Benefício
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Conduta Expectante
Tipo de estudo:
Etiology_studies
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Health_economic_evaluation
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
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Systematic_reviews
Aspecto:
Patient_preference
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Surgery
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Canadá