title: A cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma.
abstract: BACKGROUND
  Although prophylactic central neck dissection (pCND) may reduce future locoregional recurrence after total thyroidectomy (TT) for low-risk papillary thyroid carcinoma (PTC), it is associated with a higher initial morbidity. We aimed to compare the long-term cost-effectiveness between TT with pCND (TT+pCND) and TT alone in the institution's perspective.
  
  
  METHODS
  Our case definition was a hypothetical cohort of 100,000 nonpregnant female patients aged 50 years with a 1.5-cm cN0 PTC within one lobe. A Markov decision tree model was constructed to compare the estimated cost-effectiveness between TT+pCND and TT alone after a 20-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000 per quality-adjusted life year (QALY). Sensitivity and threshold analyses were used to examine model uncertainty.
  
  
  RESULTS
  Each patient who underwent TT+pCND instead of TT alone cost an extra US$34.52 but gained an additional 0.323 QALY. In fact, in the sensitivity analysis, TT+pCND became cost-effective 9 years after the initial operation. In the threshold analysis, none of the scenarios that could change this conclusion appeared clinically possible or likely. However, TT+pCND became cost-saving (i.e., less costly and more cost-effective) at 20 years if associated permanent vocal cord palsy was kept ≤ 1.37 %, permanent hypoparathyroidism was ≤ 1.20 %, and/or postoperative radioiodine ablation use was ≤ 73.64 %.
  
  
  CONCLUSIONS
  In the institution's perspective, routine pCND for low-risk PTC began to become cost-effective 9 years after initial surgery and became cost-saving at 20 years if postoperative radioiodine use and/or permanent surgical complications were kept to a minimum.
authors.affiliation: Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong.
authors.forename: Carlos K H
authors.initials: CK
authors.lastname: Wong
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
mesh_terms: D002291:Carcinoma, Papillary / Q000191:economics* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D037981:Neck Dissection / Q000191:economics*; D009367:Neoplasm Staging; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D013964:Thyroid Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000191:economics*