title: Radioiodine or surgery for toxic thyroid adenoma: dissecting an important decision. A cost-effectiveness analysis.
abstract: OBJECTIVE
  To examine the cost effectiveness of therapeutic strategies for toxic thyroid adenoma.
  
  
  METHODS
  Markov state transition decision analytic model.
  
  
  METHODS
  Ambulatory and inpatient.
  
  
  METHODS
  Hypothetical cohort of 40- year-old women with toxic thyroid adenomas. Patient age was varied in sensitivity analyses. Data on the prevalence of coincident thyroid cancer, complications, and treatment efficacies were derived from a systematic review of the literature.
  
  
  METHODS
  Thyroid lobectomy after a 3 month-course of antithyroid drugs (ATDs), high-dose (<555 MBq) radioactive iodine (RAI), low-dose (>555 MBq) RAI, and lifelong ATDs.
  
  
  RESULTS
  Outcomes were measured in quality-adjusted life years (QALYs). Costs were estimated from the health care system perspective. Future costs and effectiveness were discounted at 3% per year. For a 40- year-old woman, surgery was the most effective, while low-dose RAI was the least costly. The marginal cost-effectiveness of surgery versus low-dose RAI was $13,183 per QALY. Surgery was less costly and more effective than lifelong ATDs. RAI was more effective than surgery if surgical mortality exceeded 0.90% (base-case 0.001%). Surgery provided relatively inexpensive gains (<$50,000 per QALY) in quality-adjusted life expectancy in patients less than 74 years of age.
  
  
  CONCLUSIONS
  For most patients less than 60 years of age, surgery is an effective strategy with a reasonable cost. However, for any given patient, surgical mortality, therapeutic costs and preference must be considered in choosing an appropriate therapy.
authors.affiliation: Département de Santé publique, CHU Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, France. gwenaelle.Vidal-Trecan@univ-paris5.fr
authors.forename: Gwenaëlle M
authors.initials: GM
authors.lastname: Vidal-Trecan
authors.forename: James E
authors.initials: JE
authors.lastname: Stahl
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
mesh_terms: D000236:Adenoma / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D013956:Antithyroid Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004307:Dose-Response Relationship, Radiation; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007457:Iodine Radioisotopes / Q000191:economics / Q000627:therapeutic use*; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics; D013971:Thyrotoxicosis / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes