Managing toxic thyroid adenoma: a cost-effectiveness analysis.
OBJECTIVE
To examine the cost-effectiveness of therapeutic strategies for patients with toxic thyroid adenoma.


METHODS
A decision analytic model was used to examine strategies, including thyroid lobectomy after a 3-month course of antithyroid drugs (ATDs), radioactive iodine (RAI), and lifelong ATDs followed by either RAI (ATD-RAI) or surgery (ATD-surgery) in patients suffering severe drug reactions.


METHODS
Outcomes were measured in quality-adjusted life years. Data on the prevalence of co-incident thyroid cancer, complications and treatment efficacies were derived from a systematic review of the literature (1966-2000). Costs were examined from the health care system perspective. Costs and effectiveness were examined at their present values. Discounting (3% per year), variations of major cost components, and every variable for which disagreements exist among studies or expert opinion were examined by sensitivity analyses.


RESULTS
For a 40-year-old woman, surgery was both the most effective and the least costly strategy (Euro 1391),while ATD-RAI cost the most (Euro 5760). RAI was more effective than surgery if surgical mortality exceeded 0.6% (base-case 0.001%). RAI become less costly for women of more than 72 years (more than 66 in discounted analyses). For women of 85, ATD-RAI may be more effective than RAI and have an inexpensive marginal cost-effectiveness ratio (Euro 4975) if lifelong follow-up results in no decrement in quality of life.


CONCLUSIONS
Age, surgical mortality, therapeutic costs and patient preference must all be considered in choosing an appropriate therapy.
Vidal-Trecan
Gwenaelle M
GM
Departement de sante publique, CHU Cochin Port Royal, Assistance Publique-Hopitaux de Paris, Universite Rene Descartes, Paris, France. gwenaelle.Vidal-Trecan@cochin.univ-paris5.fr
Stahl
James E
JE
Durand-Zaleski
Isabelle
I
D000236:Adenoma / Q000150:complications / Q000191:economics* / Q000628:therapy*; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D013956:Antithyroid Agents / Q000009:adverse effects / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003662:Decision Theory; D005260:Female; D006295:Health Resources / Q000191:economics; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D018803:Models, Economic; D011788:Quality of Life; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D013964:Thyroid Neoplasms / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D013971:Thyrotoxicosis / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D007457:Iodine Radioisotopes