Faculty Collaboration Database

To stimulate or withdraw? A cost-utility analysis of recombinant human thyrotropin versus thyroxine withdrawal for radioiodine ablation in patients with low-risk differentiated thyroid cancer in the United States. J Clin Endocrinol Metab 2010 Apr;95(4):1672-80

Date

02/09/2010

Pubmed ID

20139234

DOI

10.1210/jc.2009-1803

Scopus ID

2-s2.0-77951632915 (requires institutional sign-in at Scopus site)   40 Citations

Abstract

CONTEXT: Use of recombinant human TSH (rhTSH) prior to radioactive iodine remnant ablation for patients with differentiated thyroid cancer avoids the hypothyroid state and improves quality of life. European studies have shown that use of rhTSH vs. thyroid hormone withdrawal is a cost-effective method for preparing patients for ablation.

OBJECTIVE: The objective of the study was to determine the cost-utility of rhTSH prior to ablation in the United States.

DESIGN/SETTING/SUBJECTS: A Markov decision model was developed for a hypothetical group of adult patients with low-risk differentiated thyroid cancer who were prepared for ablation by either rhTSH or thyroid hormone withdrawal. Patients entered the model after initial thyroidectomy; follow-up was in accordance with current American Thyroid Association guidelines. Input data were obtained from the literature, Medicare reimbursement schedule, and U.S. Bureau of Labor Statistics. Sensitivity analyses were performed for all clinically relevant inputs.

MAIN OUTCOME MEASURES: Cost-utility, measured in U.S. dollars per quality-adjusted life-year ($/QALY), was measured.

RESULTS: Use of rhTSH yielded an incremental cost-utility of $52,554/QALY (95% confidence interval $52,058-53,050/QALY) (incremental societal cost of $1,365/patient; incremental benefit of 0.026 QALY/patient). The majority of cost and benefit occurs during the preablation, ablation, and postablation period; differences in cost are due to cost of rhTSH and differences in productivity loss (days off work). The model was most sensitive to changes in time off work, cost of rhTSH, and differences in utilities of health states.

CONCLUSIONS: In the United States, the cost-effectiveness of rhTSH for ablation in patients with low-risk differentiated thyroid cancer is highly dependent on potential variations in cost of rhTSH, rates of remnant ablation, time off work, and quality of life.

Author List

Wang TS, Cheung K, Mehta P, Roman SA, Walker HD, Sosa JA

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Cost-Benefit Analysis
Costs and Cost Analysis
Decision Support Techniques
Decision Trees
Female
Humans
Iodine Radioisotopes
Male
Markov Chains
Neoplasm Recurrence, Local
Quality-Adjusted Life Years
Recombinant Proteins
Thyroid Neoplasms
Thyroidectomy
Thyrotropin
Thyroxine
United States