Surgery alone for papillary thyroid microcarcinoma is less costly and more effective than long term active surveillance

Lin, Jia Feng; Jonker, Pascal; Cunich, Michelle; Sidhu, Stanley; Delbridge, Leigh; Glover, Anthony; Learoyd, Diana; Aniss, Ahmad; Kruijff, Schelto; Sywak, Mark

doi:10.1016/j.surg.2019.05.078

Cited by 54 publications

(36 citation statements)

References 21 publications

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“…An increase in cost associated with need for ongoing surveillance was also independently demonstrated by Balentine and colleagues who estimated that the lobectomy cost of $6,100 per nodule was significantly less than that for molecular testing (Afirma, $9,400) when calculated over a 5-year period ( 59 ). Indeed, Lin and colleagues have estimated that while surgery upfront is more expensive than annual surveillance, this cost difference is reversed by just 16 years of surveillance, which is considerably less than the expected lifespan of these patients ( 60 ). Thus, in the long term, surgery may in fact be more cost effective than surveillance for high risk nodules.…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

Thyroid Nodule Molecular Testing: Is It Ready for Prime Time?

Khan

Zeiger

2020

Front. Endocrinol.

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Cytologically indeterminate thyroid nodules remain a diagnostic and clinical challenge, and molecular testing has been advocated and advanced as a diagnostic modality to help guide treatment. While studies have expounded on the improved diagnostic certainty with these tests, data demonstrating meaningful clinical impact and supporting their routine use is still limited at best. In this review, we discuss the limitations regarding diagnostic accuracy, impact on surgical decision-making and outcomes, and cost-effectiveness of molecular testing. By highlighting the limitations of these tests, we aim to promote more thoughtful utilization of these tools in the management of thyroid nodules going forward.

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Section: Cost-effectiveness Analysismentioning

confidence: 99%

Thyroid Nodule Molecular Testing: Is It Ready for Prime Time?

Khan

Zeiger

2020

Front. Endocrinol.

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“…The non-surgical approach was more cost-effective than immediate surgery during the first 16 years after PTMC diagnosis and thereafter, regardless of patient age (< 40 and ≥ 40 years), complications, and progression rates ( 109 ). However, one may found some opposite data pointing on better cost-effectiveness of surgery compared to active surveillance in PTMC ( 110 , 111 ). Australian data showed the cost of surgical therapy of 10,226 Australian dollars, whereas hypothetic active surveillance 756 Australian dollars per year.…”

Section: Quality Of Life Psychological and Economic Considerationsmentioning

confidence: 99%

“…Australian data showed the cost of surgical therapy of 10,226 Australian dollars, whereas hypothetic active surveillance 756 Australian dollars per year. So, the cost of surgery corresponded to the cost of 16.2 years of active surveillance ( 111 ).…”

Section: Quality Of Life Psychological and Economic Considerationsmentioning

confidence: 99%

Early Diagnosis of Low-Risk Papillary Thyroid Cancer Results Rather in Overtreatment Than a Better Survival

et al. 2020

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We are witnessing a rapid worldwide increase in the incidence of papillary thyroid carcinoma (PTC) in the last thirty years. Extensive implementation of cancer screening and wide availability of neck ultrasound or other imaging studies is the main reason responsible for this phenomenon. It resulted in a detection of a growing number of clinically asymptomatic PTCs, mainly low-risk tumors, without any beneficial impact on survival. An indolent nature of low-risk PTC, particularly papillary thyroid microcarcinoma (PTMC), and the excellent outcomes raise an ongoing discussion regarding the adequacy of treatment applied. The question of whether PTMC is overtreated or not is currently completed by another, whether PTMC requires any treatment. Current ATA guidelines propose less extensive preoperative diagnostics and, if differentiated thyroid cancer is diagnosed, less aggressive surgical approach and limit indications for postoperative radioiodine therapy. However, in intrathyroidal PTMCs in the absence of lymph node or distant metastases, active surveillance may constitute alternative management with a low progression rate of 1%–5% and without any increase in the risk of poorer outcomes related to delayed surgery in patients, in whom it was necessary. This review summarizes the current knowledge and future perspectives of active surveillance in low-risk PTC.

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“…They found that for patients under AS, the cost-effectiveness of hemithyroidectomy decreased both the QoL and life expectancy 49 . Lin et al 50 compared the costs of surgery versus hypothetic AS for PTMC in an Australian cohort of 349 patients. They found that the estimated cost of PTMC surgical treatment ($10,226 Australian dollars) was equivalent to the cost of 16.2 years of AS ($756 Australian dollars/year).…”

Section: Some Concerns About Asmentioning

confidence: 99%