Cost-Effectiveness of Active Surveillance Compared to Early Surgery of Small Papillary Thyroid Cancer: A Retrospective Study on a Korean Population

Abstract

Background Recently, active surveillance (AS) has been introduced as an alternative to early surgery (ES) for the management of papillary thyroid microcarcinoma (PTMC), because of its indolent features and low mortality. However, its cost effects have not been determined and the findings of current studies differ, according to each country’s medical system. Methods A Markov model was constructed to compare the cost-effectiveness of AS and ES, based on a reference case of a 40-year-old patient diagnosed with PTMC. Costs and transition probabilities were derived from previous clinical studies in Korean populations, and the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated. The willingness-to-pay (WTP) threshold was set at USD 100,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address the uncertainties in the model’s variables. Results From the base scenario, the cumulative costs and effectiveness were both higher in ES than AS. The ICER for ES, compared with AS, was USD 6,619.86/QALY, lower than the set WTP. The NMB difference between AS and ES increased across the stages (USD 5,980 at the first stage and USD 159,667 at the last stage). The ICER increased along with decreasing age and increasing cost of surgery. The higher the ES utility score and the lower that of AS, the more cost-effective ES, with WTP set at USD 30,000. Conclusion In the current Korean medical system, ES is more cost-effective than AS. ES is more cost-effective as it is diagnosed at young age and followed-up for a long time.

Papillary thyroid carcinoma: ≤ 10 mm does not always mean pN0. A multicentric real-world study

“…Most of them motivate the preference for the early surgical approach with psychological tumour burden [ 34 ]. Furthermore, data have already been published demonstrating better long-term cost effectiveness for early PTMC surgery rather than long active surveillance [ 35 ].…”

Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population

“…To reflect this scenario, the following seven health states were assumed in the analysis model: healthy, benign, post-hemithyroidectomy surveillance without complication, post-hemithyroidectomy surveillance with complication, post-TT surveillance without complication, post-TT surveillance with complication, and death (Supplemental Figs. S1, S2A) [22,23]. We considered long-term complications such as hypocalcemia induced by post-procedural hypoparathyroidism or hypothyroidism by mostly thyroidectomy in defining the health status.…”