title: Cost-effectiveness of using recombinant human TSH prior to radioiodine ablation for thyroid cancer, compared with treating patients in a hypothyroid state: the German perspective.
abstract: OBJECTIVE
  This investigation evaluated the cost-effectiveness of radioiodine remnant ablation following preparation with recombinant human TSH (rhTSH), compared with the standard preparation, whereby patients are rendered hypothyroid.
  
  
  METHODS
  The economic evaluation relates to patients with well differentiated thyroid cancer who have undergone thyroidectomy, but have no metastases. The evaluation takes a societal perspective, considering costs and benefits to all parties. The benefits were expressed in units of quality-adjusted life years (QALY), so differences in life expectancy were captured with consideration of quality of life.
  
  
  METHODS
  A lifetime Markov model with Monte Carlo simulation of 100,000 patients was used to assess cost per QALY gained. The clinical inputs were sourced from a multi-centre, randomised controlled trial comparing remnant ablation success after rhTSH-preparation with hypothyroid preparation. The model applied German unit costs, however, the structure is generalisable to other jurisdictions. The additional cost of rhTSH procurement and administration is considered relative to the clinical benefits and cost offsets. These included avoidance of hypothyroidism, increased work productivity, earlier discharge from radioprotection and a theoretical reduction in the risk of secondary malignancy. The latter two benefits relate to faster radioiodine clearance after rhTSH preparation.
  
  
  RESULTS
  The additional benefits of rhTSH (0.0495 QALY) are obtained with an incremental societal cost of 47 euro, equating to an incremental cost per QALYof 958 euro. Sensitivity analyses had only a modest impact upon cost-effectiveness, with all one-way sensitivity results remaining under 15,000 euro/QALY.
  
  
  CONCLUSIONS
  The use of rhTSH prior to radioiodine ablation represents good value-for-money with the benefits to patient and society obtained at modest net cost.
authors.affiliation: Health Technology Analysts Pty Ltd, PO Box 133, Balmain, Sydney 2041, Australia. pmernagh@htanalysts.com
authors.forename: P
authors.initials: P
authors.lastname: Mernagh
authors.forename: S
authors.initials: S
authors.lastname: Campbell
authors.forename: M
authors.initials: M
authors.lastname: Dietlein
authors.forename: M
authors.initials: M
authors.lastname: Luster
authors.forename: E
authors.initials: E
authors.lastname: Mazzaferri
authors.forename: A R
authors.initials: AR
authors.lastname: Weston
mesh_terms: D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004526:Efficiency; D005858:Germany; D006304:Health Status; D006801:Humans; D007037:Hypothyroidism / Q000191:economics*; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008390:Markov Chains; D018803:Models, Economic; D015233:Models, Statistical; D009010:Monte Carlo Method; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000191:economics* / Q000628:therapy*; D013965:Thyroidectomy; D013972:Thyrotropin / Q000627:therapeutic use*
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin