This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Endocrine Disease of Head & Neck  • Surgery  • Endocrine Surgery  • Endocrine Diseases  • Thyroid/ Parathyroid Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Mark G. Shrime, MD; David P. Goldstein, MD, FRCSC; Raewyn M. Seaberg, MD, PhD; Anna M. Sawka, MD, PhD, FRCPC; Lorne Rotstein, MD, FRCSC; Jeremy L. Freeman, MD, FRCSC; Patrick J. Gullane, MD, FRCSC

Arch Otolaryngol Head Neck Surg. 2007;133(12):1245-1253.

Objective  To compare the 20-year cost-effectiveness of initial hemithyroidectomy vs total thyroidectomy in the management of small papillary thyroid cancer in the low-risk patient.

Design  Pooled data from the published literature were used to determine key statistics for decision analysis such as rates of recurrence, rates of complications for all interventions undertaken, and rates of death. The 2005 costs were obtained from the US Department of Health and Human Services, as well as from Medicare reimbursement schedules. Future costs were discounted at 6%.

Setting  Decision analysis study.

Patients  Data from the published literature.

Main Outcome Measures  A state-transition (Markov) decision model was constructed based on the most recent American Thyroid Association recommendations. A cost-effectiveness analysis was performed using fixed probability estimates and Monte Carlo microsimulation, with effectiveness defined as cause-specific mortality or recurrence-free survival. After identifying initial results, sensitivity and threshold analyses were performed to assess the strength of the recommendations.

Results  Initial probability estimates were determined from a review of 940 abstracts and 31 relevant studies examining outcomes in patients with low-risk thyroid cancer undergoing thyroidectomy or neck dissection. During 20 years, cost estimates (including initial surgery, follow-up, and treatment of recurrence) were between $13 896.81 and $14 241.24 for total thyroidectomy and between $15 037.58 and $15 063.75 for hemithyroidectomy. Cause-specific mortality was similar for both treatment strategies, but recurrence-free survival was higher in the total thyroidectomy group. Sensitivity and threshold analyses demonstrated that these results were sensitive to rates of recurrence and cost of follow-up but remained robust when compared with willingness to pay.

Conclusions  Total thyroidectomy dominates over hemithyroidectomy as initial treatment for low-risk papillary thyroid cancer. However, in sensitivity analyses, these results varied by institution because of heterogeneity in long-term treatment outcomes. With changing protocols of management, it is possible that hemithyroidectomy will emerge as being more cost-effective. Long-term prospective trials are necessary to validate our findings.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Shrime, Goldstein, Seaberg, and Gullane), Endocrinology and Medicine (Dr Sawka), and Surgery (Dr Rotstein), University of Toronto Health Network, and Department of Otolaryngology–Head and Neck Surgery, Mt Sinai Hospital (Dr Freeman), Toronto, Ontario, Canada. Dr Shrime is now with Princess Margaret Hospital, Toronto.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Decision Analysis of Discordant Thyroid Nodule Biopsy Guideline Criteria
McCartney and Stukenborg
J. Clin. Endocrinol. Metab. 2008;93:3037-3044.
ABSTRACT | FULL TEXT