Rising Cost of Thyroid Surgery in Adult Patients

Sahli, Zeyad T.; Zhou, Sheng; Sharma, Ashwyn K.; Segev, Dorry L.; Massie, Allan B.; Zeiger, Martha A.; Mathur, Aarti

doi:10.1016/j.jss.2020.11.049

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…Furthermore, the clinical impact of nerve injuries is also associated with a significant economic burden [43,44], with a necessity for future investigations on health-technologyassessment (HTA) and cost-effectiveness analysis, as already carried out for thyroid surgery [34]. Finally, a medico-legal issue has to be considered when dealing with technologies which might improve surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

Polistena

Ranalli

Avenia

et al. 2021

JCM

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Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015–2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017–2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

Polistena

Ranalli

Avenia

et al. 2021

JCM

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“…Further, the cost of thyroid surgery has risen, with an annual increase of 4.3% between 2006 and 2014, resulting in a total increase of 38.8% over 9 years [52]. Outside of initial treatment, surveillance costs contribute to ongoing financial burden of care with an estimated surveillance cost for differentiated thyroid cancer of $1225 for low-risk, $1760 for intermediate-risk, and $2774 for high-risk patients per patient over a 3-year period [53].…”

Section: Financial Toxicity In Thyroid Cancer Survivorsmentioning

confidence: 99%

Financial toxicity in thyroid cancer survivors

Bogdanovski

Sturgeon

James

2023

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Financial burden and distress are high in patients with thyroid cancer. However, little has been done to evaluate potential interventions to mitigate financial toxicity in survivors. This review will cover current data on the impact of financial toxicity on quality of life and clinical outcomes in patients with thyroid cancer and highlight areas for future study. Recent findings Thyroid cancer incidence has nearly tripled in the past decades, and cost of treatment is predicted to rise more than other cancers over the next decade. With mean age of diagnosis at 51 years, most patients begin treatment while still working, do not qualify for Medicare or Social Security, and are susceptible to higher financial burden. Though thyroid cancer has high survival rates, some studies suggest patients have worse quality of life and higher financial burden than more morbid cancers. Summary Thyroid cancer survivors have high rates of financial toxicity, and there remains need for longitudinal studies to evaluate how financial burden may change during the treatment process while also assessing potential tools to mitigate this burden.

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“…Despite the progressive increase in incidence, the disease-specific mortality in the US has increased marginally from 0.40 to 0.46 per 100,000 and can be accounted for by the advanced and dedifferentiated cancers that occur most commonly in an ageing population [9]. In 2020, 43,646 patients died from thyroid cancer (27,740 women and 15,906 men) (Global Cancer Observatory, IARC), almost no change from the 40,000 estimated global deaths in 2012 [6]. These trends of incidence and mortality are seen across the developed world, with pockets of extreme increase in incidence in countries where thyroid screening has been adopted, such as in South Korea [5,10,11].…”

Section: Epidemiology Of Dtcmentioning

confidence: 99%

“…Thyroid surgery is becoming increasingly expensive. A large population-based study demonstrated increasing patient charges for both inpatient and outpatient elective thyroid surgery, with increasing costs of £644 or 4.31% every year between 2006 and 2014, after controlling for multiple clinical and demographic variables and adjusting for inflation [ 43 ]. There is ample evidence that a thyroid lobectomy presents no survival difference compared to a total thyroidectomy in low-risk PTC less than four centimetres in diameter [ 44 ].…”

Section: Surgery As the Solution?mentioning

confidence: 99%

“…Naturally, these devices may have advantages to offer in some cases, possibly reducing morbidity or the time of surgery, but always at a cost. The technology adds to the total costs associated with thyroid surgery, as was demonstrated using the Nationwide Inpatient Sample (NIS) database [ 55 ] and Premier Healthcare Database [ 43 ]. However, often the enthusiasm for new technology has meant that a rigorous cost-effectiveness/value analysis is not performed until the devices have become ingrained in surgical practice.…”

Section: Surgical Technology: a Cost-effective Addition?mentioning

confidence: 99%

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Differentiated Thyroid Cancer: A Health Economic Review

Heede

Tolley

Marco

et al. 2021

Cancers

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The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients’ costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.

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Rising Cost of Thyroid Surgery in Adult Patients

Cited by 11 publications

References 19 publications

The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

Financial toxicity in thyroid cancer survivors

Differentiated Thyroid Cancer: A Health Economic Review

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