Treatment room length-of-stay and patient throughput with radioiodine thyroid remnant ablation in differentiated thyroid cancer

Abstract

Relative to THW, rhTSH use to aid ablation reduced mean treatment room length-of-stay by almost one-third and more than doubled the average weekly patient throughput, both of which were significant differences.

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

“…Authors did not comment on the length and extent of this phenomenon. In addition, neither the hospital length of stay (2.6 vs 2.8 days) nor the sick leave time (23 vs. 24 days) appeared to be significantly different, in contrast to other retrospective reports [7,8]. We remind that length of stay is mainly driven by how each nuclear medicine ward is organized (number of beds, use of beds -7/7 or just Monday to Fridaypresence/absence of waiting lists) and, above all, by the remuneration system.…”

“…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.…”

“…Therefore, we decided to run the base case scenario under the most conservative assumptions, assuming no difference in length of stay. However, in the sensitivity analysis we relaxed our hypothesis and assumed an earlier discharge for Thyrogen ® treated patients (Borget reported a reduction from 3.5 to 2.4 days in 2008 [7], whereas Vallejo-Casas in 2011 documented 1.41 vs. 2.02 days [8]); in this scenario, Thyrogen ® dominates endogenous stimulation by providing better QoL outcomes along with cost savings. In a strict analogy and despite their paramount importance, we excluded societal benefits such as productivity gains in the base case analysis.…”

“…This is quite relevant since driving habits appear to be difficult to change in at least 30% of THW cases, irrespectively of a strong negative medical advice [4]. The use of Thyrogen ® may also improve overall ward efficiency, lowering fixed costs and halve waiting lists, in analogy of what measured in other countries [8,24]. Little is known about the real organizational aspects related to ablation and isolation rooms in Italian hospitals, as a consequence of the shorter length of stay and the more exact scheduling of admissions and discharges.…”

“…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].…”