Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen

Borget, Isabelle; Rémy, Hervé; Chevalier, Julie; Ricard, M.; Allyn, Mark; Schlumberger, Martin; Pouvourville, Gérard de

doi:10.1007/s00259-008-0754-9

Cited by 64 publications

(42 citation statements)

References 18 publications

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“…The length of stay for exogenously and endogenously-stimulated patients, in absence of local data, were assumed to be the same. This assumption is conservative (thus penalizing Thyrogen ® ) since there is a solid body of evidence linking Thyrogen ® to a faster clearance of 131I after radioiodine ablation [6,15,16], leading to a shorter stay in the radioprotective ward [7,8,17]. Differences in the length of stay, using literature data, were tested in the sensitivity analysis.…”

Section: Length Of Stay In Radioprotective Wardmentioning

confidence: 99%

“…The cost of hospitalization had no impact in the base case analysis because we assumed that the length of stay was only dependent on the activity of radioiodine received. The daily cost of hospitalization was therefore tested using length of stay estimates from Borget et al [7] at the dIscussIon Thyrogen ® avoids daily life disruptions and preserves patients' QoL, whereas thyroid hormone withdrawal (THW) has been shown to produce a QoL deterioration greater than that of heart failure, depression and migraine headache [19,27]. The patients' perspective on the desirability of these two alternatives is evidenced by the finding that between 86% and 97% of interviewed patients favored rhTSH over THW [28,29].…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…Avoidance of hypothyroidism via Thyrogen ® therapy has been found to be associated with consequent better health-related quality of life, little or no productivity loss and a reduction in the need for GP visits or medications [4]. In addition, use of Thyrogen ® has been shown to allow a shorter duration of the preablative period and a faster radioiodine clearance rate [5,6] with the possibility of less radiation exposure to non-targeted organs and earlier discharge from radioprotective wards [7,8].…”

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confidence: 99%

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Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

Danieli

Monari

Lazzarini

et al. 2016

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BACKGROUND: Radioiodine ablation is an adjuvant procedure used to treat patients with differentiated thyroid cancer. For ablation to be successful, patients must have elevated levels of thyroid stimulating hormone (TSH). This can be achieved by withholding thyroid hormone therapy (endogenous stimulation), or by administration of recombinant human thyroid stimulating hormone (rhTSH; Thyrogen®; exogenous stimulation) to patients in the euthyroid state.AIM: To compare the estimated health benefits, cost and cost-effectiveness of TSH stimulation with and without Thyrogen® in the Italian setting.METHODS: A cost-utility analysis was undertaken to assess the impact of exogenous vs. endogenous TSH stimulation before radioiodine remnant ablation of patients with newly diagnosed, well-differentiated papillary or follicular thyroid cancer who have undergone total or near-total thyroidectomy. A Markov model was developed to simulate treatment costs and health outcomes associated with exogenous and endogenous stimulation in four distinct health states: pre-ablation, ablation, post-ablation, and well/recovery. Treatment was stratified by patients who receive high- and low-activity (30-100 mCi, respectively) in the ablation state. The Italian National Health System perspective was adopted in the base case scenario while the impact of indirect costs was explored in a sensitivity analysis. Costs and quality-adjusted life years (QALY) specific to each health state were estimated, summarized and converted into a corresponding incremental cost-effectiveness ratio (ICER).RESULTS: We calculated a cost-effectiveness ratio of 18,357.18 €/QALY gained whereas the inclusion of indirect cost and accident cost produced reductions of the ICER to € 14,609.51 and € 15,515.26 per QALY, respectively. Finally, all results in the sensitivity analysis are below the lower bound of national and international cost- effective threshold.CONCLUSION: Thyrogen® represents a cost-effective option for patients with differentiated thyroid cancer who underwent total or near-total thyroidectomy in Italy. Our findings are consistent with other cost-utility analyses.

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Section: Length Of Stay In Radioprotective Wardmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

Danieli

Monari

Lazzarini

et al. 2016

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“…The modeled simulations predicted a length of stay of 2.4 days for patients who received rhTSH preparation compared to 3.5 days for THW preparation (p Ͻ 0.001). This resulted in a savings of 338, which would defray approximately half the cost of thyrotropin alfa administration (Borget et al 2008). An economic analysis from a societal perspective evaluated quality of life improvements from avoiding hypothyroidism, increased work productivity, earlier discharge from a radiation safety perspective and theoretical reduction in risk of secondary malignancy.…”

Section: Quality Of Lifementioning

confidence: 99%

Recombinant human thyroid stimulating hormone in 2008: focus on thyroid cancer management

Gramza

Schuff

2009

OTT

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Radioiodine (RAI) ablation following thyroidectomy is standard of care treatment for patients with intermediate or high risk differentiated thyroid cancer. Traditionally, this has been achieved by forgoing thyroid hormone replacement postoperatively, allowing endogenous thyroid stimulating hormone (TSH) levels to rise. This rise in TSH provides the stimulus for RAI uptake by the thyroid remnant, but is associated with clinical hypothyroidism and its associated morbidities. Recombinant human TSH (rhTSH, thyrotropin alfa [Thyrogen ® ], Genzyme Corporation, Cambridge, MA, USA) was developed to provide TSH stimulation without withdrawal of thyroid hormone and clinical hypothyroidism. Phase III studies reported equivalent detection of recurrent or residual disease when rhTSH was used compared with thyroid hormone withdrawal (THW). These trials led to its approval as an adjunctive diagnostic tool for serum thyroglobulin (Tg) testing with or without RAI imaging in the surveillance of patients with differentiated thyroid cancer. Recently, rhTSH was given an indication for adjunctive preparation for thyroid remnant ablation after phase III studies demonstrated comparable outcomes for rhTSH preparation when compared with THW. Importantly, rhTSH stimulation has been found to be safe, well tolerated, and to result in improved quality of life. Here, we review the effi cacy and tolerability studies leading to the approval for the use of rhTSH in well-differentiated thyroid cancer management.

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“…Although the activity necessary to achieve a comparable rate of ablation is probably higher than that required under hypothyroidism [3,4], the use of rhTSH is associated with a lower whole-body radiation exposure [5] and allows a shorter hospitalization length, which partially compensates for its cost [6].…”

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confidence: 99%

What role for recombinant human TSH in the treatment of metastatic thyroid cancer?

Zanotti‐Fregonara

Hindié

Toubert

et al. 2009

Eur J Nucl Med Mol Imaging

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The introduction into clinical practice of recombinant human thyroid-stimulating hormone (rhTSH) has marked a turning point in the management of patients with differentiated thyroid cancer. RhTSH offers a safe and reliable alternative to thyroid hormone withdrawal by avoiding both the clinical consequences of hypothyroidism, with a positive impact on quality of life and work productivity, and the potential risk of cancer growth due to a long-lasting endogenous TSH stimulation.In the follow-up of thyroid cancer patients, rhTSH stimulated thyroglobulin is now routinely proposed as it has been shown to be as sensitive as endogenously stimulated thyroglobulin for the detection of residual and metastatic cancer [1].More recently, the use of rhTSH has been approved for the preparation of adult low-risk patients for postsurgical radioiodine ablation of thyroid remnants with 3.7 GBq 131 I [2]. Although the activity necessary to achieve a comparable rate of ablation is probably higher than that required under hypothyroidism [3,4], the use of rhTSH is associated with a lower whole-body radiation exposure [5] and allows a shorter hospitalization length, which partially compensates for its cost [6].The use of rhTSH in the treatment of metastatic thyroid cancer is much more controversial. Although rhTSH has not been formally approved so far for this indication, it has been used off-label since the 1990s to treat patients in which thyroid hormones could not be stopped [7]. This includes patients unable to raise an adequate endogenous TSH response, either because of hypopituitarism or continued production of thyroxine by a thyroid remnant or metastatic tumour, and patients in poor condition due to advanced disease. The results obtained in some patients are encouraging.One may raise the question whether a wider use of rhTSH can be advovated in the therapeutic setting. In our opinion, both clinical and biological data from the literature argue against a more liberal use of rhTSH for the therapy of metastatic thyroid cancer. First, tumour cells of thyroid cancer have a reduced expression of most thyroid-specific genes, including the TSH receptor and the Na + /I − symporter (NIS) gene [8]. Although the standard two injections protocol of rhTSH provides a high plasma TSH peak, roughly in the range 100-150 mIU/L 24 h after the second injection [9], the concentration increase is short-lived [10]. In order to improve the number of NIS and TSH receptors, and thus enhance the iodine-trapping ability of the cells, a high and prolonged period of TSH stimulation elevation is desirable [11]. Indeed, a 131 I whole-body scan under hypothyroidism is more sensitive than the same scan after rhTSH administration [12]. It should be remembered that a posttherapeutic scan of good quality is an invaluable tool to discover unsuspected metastases and to assess the efficacy of repeated 131 I treatment in metastatic patients [13].Second, published experience shows that rhTSH stimulates the uptake of radioiodine in metastatic lesions [7]. However, prospec...

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Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen

Abstract: By increasing the iodine excretion, rhTSH allows a shorter hospitalization length, which partially compensates its acquisition cost.

Cited by 64 publications

References 18 publications

Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

Recombinant human thyroid stimulating hormone in 2008: focus on thyroid cancer management

What role for recombinant human TSH in the treatment of metastatic thyroid cancer?

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