Radioiodine or surgery for toxic thyroid adenoma: dissecting an important decision. A cost-effectiveness analysis.
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.
Vidal-Trecan
Gwenaëlle M
GM
Département de Santé publique, CHU Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, France. gwenaelle.Vidal-Trecan@univ-paris5.fr
Stahl
James E
JE
Eckman
Mark H
MH
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
D013956:Antithyroid Agents; D007457:Iodine Radioisotopes