Recombinant human TSH versus hypothyroidism. Cost-minimization-analysis in the follow-up care of differentiated thyroid carcinoma.
The primary aim of this study was to compare pharmacoeconomic effects of hypothyroidism secondary to hormone withdrawal (THW) and recombinant human TSH (rhTSH) for follow-up WBS in patients with differentiated thyroid cancer (DTC). The second aim was to determine patients' preference for one procedure or the other.


METHODS
This retrospective survey included 327 patients with DTC who underwent at least one in-hospital WBS with rhTSH between 1999 and 2006. They had also undergone THW for WBS. Patients received a two-page questionnaire via mail addressing five symptoms and ten items regarding managing their daily life which was answered by 61.6%. The responder group did not differ from the entire group. The medical and societal cost of both procedures for diagnostic WBS was calculated including direct and all ascertainable indirect cost for the reference year 2005. A sensitivity analysis included the German DRG system of 2007 and 2010.


RESULTS
After THW, 94% of patients reported hypothyroid symptoms. Using rhTSH, symptoms occurred significantly less. As a result, 97% of patients favored rhTSH over THW. Mean absence from salaried work was 12.3 days after THW compared to 4 days with rhTSH. Family members of salaried employees missed 3 and 0.7 workdays after THW and rhTSH, respectively. Almost twice as often, medical attention was sought after THW (36%) compared to rhTSH (19 %). Undergoing THW, 48% of patients still used their car while hypothyroid. Our cost calculation revealed a slight benefit of about 89.00 Euro in favour of rhTSH stimulation.


CONCLUSIONS
Hypothyroidism after THW causes significant morbidity and safety risks. The clinical and societal benefits associated with rhTSH are roughly gained at equivalent overall cost to that of THW.
Dietlein
M
M
Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Kerpener Str. 62, 50937 Köln, Germany. markus.dietlein@uni-koeln.de
Busemeyer
S
S
Kobe
C
C
Schmidt
M
M
Theissen
P
P
Schicha
H
H
D002277:Carcinoma; D002291:Carcinoma, Papillary; D005221:Fatigue / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced; D008297:Male; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use*; D013954:Thyroglobulin / Q000009:adverse effects / Q000097:blood / Q000187:drug effects; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000097:blood / Q000188:drug therapy*; D013972:Thyrotropin / Q000191:economics / Q000235:genetics / Q000627:therapeutic use*; D057073:Thyrotropin Alfa / Q000627:therapeutic use
D011994:Recombinant Proteins; D057073:Thyrotropin Alfa; D013972:Thyrotropin; D013954:Thyroglobulin