Faculty Collaboration Database

Cost analysis of thyroid lobectomy and intraoperative frozen section versus total thyroidectomy in patients with a cytologic diagnosis of "suspicious for papillary thyroid cancer". Surgery 2013 Dec;154(6):1307-13; discussion 1313-4

Date

11/19/2013

Pubmed ID

24238049

DOI

10.1016/j.surg.2013.06.031

Scopus ID

2-s2.0-84887986047 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: The optimal operation for a patient with a thyroid nodule "suspicious for papillary thyroid cancer (PTC)" on fine-needle aspiration (FNA) is unclear. This study examines the incremental cost-utility of thyroid lobectomy with intraoperative frozen section (thyroid lobectomy) versus total thyroidectomy.

METHODS: Cost-utility analysis was performed for patients with a cytologic diagnosis of "suspicious for PTC" on FNA. Patients underwent either initial total thyroidectomy or thyroid lobectomy and, if needed, completion thyroidectomy. The incremental cost-utility ratio (ICUR; US$/quality-adjusted-life-year [QALY]), was determined from a societal perspective.

RESULTS: The base-case ICUR of thyroid lobectomy is $90,776/QALY, strongly favoring total thyroidectomy as a more cost-effective modality. On sensitivity analyses, the model is sensitive to the accuracy of frozen section and to the rate of injury to the recurrent laryngeal nerve (RLN). Thyroid lobectomy is more cost-effective only if both frozen section and final pathology are benign in ≥92% of patients (ICUR $47,959/QALY at 92%). With increasing rates of unilateral (>5%) or bilateral (>2%) RLN injury associated with total thyroidectomy, there is a trend toward thyroid lobectomy being more cost effective ($53,127 and $51,325/QALY, respectively).

CONCLUSION: In our model, initial total thyroidectomy is cost-effective for patients with a single thyroid nodule suspicious for PTC on FNA. Our results strongly support total thyroidectomy for initial treatment; thyroid lobectomy is preferred only when complications reach unacceptable levels.

Author List

Leiker AJ, Yen TW, Cheung K, Evans DB, Wang TS

Authors

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

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

Biopsy, Fine-Needle
Carcinoma
Carcinoma, Papillary
Cost-Benefit Analysis
Cytodiagnosis
Decision Trees
Frozen Sections
Humans
Models, Economic
Postoperative Complications
Quality-Adjusted Life Years
Recurrent Laryngeal Nerve Injuries
Thyroid Neoplasms
Thyroid Nodule
Thyroidectomy