Cost-effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective

Abstract

Objective: This investigation evaluated the cost-effectiveness of radioiodine remnant ablation following preparation with recombinant human TSH (rhTSH), compared with the standard preparation, whereby patients are rendered hypothyroid. Design: The economic evaluation relates to patients with well differentiated thyroid cancer who have undergone thyroidectomy, but have no metastases. The evaluation takes a societal perspective, considering costs and benefits to all parties. The benefits were expressed in units of quality-adjusted life years (QALY), so differences in life expectancy were captured with consideration of quality of life. Methods: A lifetime Markov model with Monte Carlo simulation of 100 000 patients was used to assess cost per QALY gained. The clinical inputs were sourced from a multi-centre, randomised controlled trial comparing remnant ablation success after rhTSH-preparation with hypothyroid preparation. The model applied German unit costs, however, the structure is generalisable to other jurisdictions. The additional cost of rhTSH procurement and administration is considered relative to the clinical benefits and cost offsets. These included avoidance of hypothyroidism, increased work productivity, earlier discharge from radioprotection and a theoretical reduction in the risk of secondary malignancy. The latter two benefits relate to faster radioiodine clearance after rhTSH preparation. Results: The additional benefits of rhTSH (0.0495 QALY) are obtained with an incremental societal cost of V47, equating to an incremental cost per QALY of V958. Sensitivity analyses had only a modest impact upon cost-effectiveness, with all one-way sensitivity results remaining under V15 000/QALY. Conclusions: The use of rhTSH prior to radioiodine ablation represents good value-for-money with the benefits to patient and society obtained at modest net cost. 155 405-414 European Journal of Endocrinology

Evaluation of whole-body retention of iodine-131 (131I) after postoperative remnant ablation for differentiated thyroid carcinoma – thyroxine withdrawal versus rhTSH administration: A retrospective comparison

“…One of the major drawbacks for its more generalized use is its cost (16). Although it is believed that it can be counterbalanced by improved productivity and reduced work absenteeism when hypothyroidism is avoided (17,18), its exact economic impact is difficult to ascertain (19). Our primary goal was to evaluate the whole-body retention time of 131 I, extrapolated from the measurements of the effective dose at a 1-m distance, associated with each strategy of preparing patients for postoperative remnant ablation with 131 I.…”

Combined treatment of the highly differentiated cancer of thyroid gland: recombinant human thyrotropin-alpha is in the focus

“…Під час використання рлТТГ, підвищення рів-ня ТТГ, необхідного для лікувальних та діагностич-них процедур, досягається на тлі замісної терапії тироксином [10][11][12][13][14]. Екзогенна стимуляція рівня ТТГ, завдяки нетривало існуючому гіпотиреозу, дозволяє уникнути майже всіх клінічних симптомів.…”

Preparation with Recombinant Humanized Thyroid-Stimulating Hormone before Radioiodine Ablation after Thyroidectomy: A Systematic Review

“…Mernagh et al 23 conducted a cost-effectiveness evaluation of rhtsh compared with hormone withdrawal and reported that the benefits of rhtsh are achieved with a small incremental societal cost of €47. That difference equates to an incremental costeffectiveness ratio of €950 per quality-adjusted life year, which is considered to be very good value for money, considering that new health care interventions are deemed cost-effective if their incremental costeffectiveness ratio falls below €45,000 23 .…”

“…That difference equates to an incremental costeffectiveness ratio of €950 per quality-adjusted life year, which is considered to be very good value for money, considering that new health care interventions are deemed cost-effective if their incremental costeffectiveness ratio falls below €45,000 23 .…”