Managing toxic thyroid adenoma: a cost-effectiveness analysis

Abstract

Objective: To examine the cost-effectiveness of therapeutic strategies for patients with toxic thyroid adenoma. Design: A decision analytic model was used to examine strategies, including thyroid lobectomy after a 3-month course of antithyroid drugs (ATDs), radioactive iodine (RAI), and lifelong ATDs followed by either RAI (ATD-RAI) or surgery (ATD-surgery) in patients suffering severe drug reactions. Methods: Outcomes were measured in quality-adjusted life years. Data on the prevalence of co-incident thyroid cancer, complications and treatment efficacies were derived from a systematic review of the literature (1966 -2000). Costs were examined from the health care system perspective. Costs and effectiveness were examined at their present values. Discounting (3% per year), variations of major cost components, and every variable for which disagreements exist among studies or expert opinion were examined by sensitivity analyses. Results: For a 40-year-old woman, surgery was both the most effective and the least costly strategy (e1391),while ATD-RAI cost the most (e5760). RAI was more effective than surgery if surgical mortality exceeded 0.6% (base-case 0.001%). RAI become less costly for women of more than 72 years (more than 66 in discounted analyses). For women of 85, ATD-RAI may be more effective than RAI and have an inexpensive marginal cost-effectiveness ratio (e4975) if lifelong follow-up results in no decrement in quality of life. Conclusions: Age, surgical mortality, therapeutic costs and patient preference must all be considered in choosing an appropriate therapy.

Lifetime follow-up care is necessary for all patients with treated thyroid nodules

“…In the cost-effectiveness analysis of Vidal-Trécan et al (4), surgically treated patients were followed for only 1 year, whereas after RAI therapy patients had lifetime follow-up care. Annual measurement of thyrotrophin (TSH) levels is indeed necessary after RAI therapy, but it is also standard practice in Germany for surgically treated patients to receive medication (levothyroxine, iodine or a combination) to compensate for iodine deficiency, to avoid elevated TSH stimulation and to prevent a recurrent goitre within the time period of four decades chosen for Vidal-Trécan's decision tree.…”

“…Interdisciplinary guidelines in Germany, authorized by the national associations of nuclear medicine, endocrinology and surgery, also give RAI administration as the therapy of choice for this indication (3). How then can the contradictory results of the cost-effectiveness analysis of Vidal-Trécan et al in France (4) be explained? This analysis shows RAI administration to be an effective therapy only in the oldest of patients.…”

“…In their 'Methods' chapter the authors Vidal-Trécan et al (4) explain their methods of estimation and decision trees, indicating the crucial factors on which their analysis is based.…”

Clinical importance of solitary solid nodule of the thyroid in endemic goiter region

“…A palpable thyroid nodule at physical examination, especially greater than 2 cm of diameter carries a considerable risk of annoying disorder. [11][12][13] Another main feature is structural (solid and cystic) nature of the nodule. Especially, management of a larger solid nodule merits a distinct importance.…”

“…Especially, management of a larger solid nodule merits a distinct importance. [11,12,14,15] A third feature is functional status of the nodule. The activity of a nodule may be established by chemical hormonal analysis and nuclear imaging method.…”