title: Routine prophylactic central neck  dissection for low-risk papillary thyroid  cancer: a cost-effectiveness analysis.
abstract: BACKGROUND
  Routine prophylactic central neck dissection (pCND) after total thyroidectomy (TTX) for low-risk papillary thyroid cancer (PTC) offers the potential to decrease disease recurrence but may increase operative complications. We hypothesized that routine pCND is not cost-effective in low-risk PTC.
  
  
  METHODS
  A Markov transition-state model was constructed to compare TTX with and without pCND. Outcome probabilities, utilities, and costs were estimated on the basis of literature review. The threshold for cost-effectiveness was $100,000 per quality-adjusted life year. Sensitivity analysis was used to examine model uncertainty.
  
  
  RESULTS
  pCND cost $10,315 and produced an effectiveness of 23.785 quality-adjusted life years. This strategy was more costly and less effective than TTX without pCND and was therefore dominated. pCND became cost-effective when the probability of recurrence increased from 6% to 10.3%, cost of reoperation for recurrence increased from $8,900 to $26,120, or added probabilities of recurrent laryngeal nerve injury and hypoparathyroidism due to pCND were less than 0.20% and 0.18% during 2-way sensitivity analysis. Monte Carlo simulation showed that pCND was not cost-effective in 97.3% of iterations.
  
  
  CONCLUSIONS
  Routine pCND for low-risk PTC is not cost-effective unless the recurrence rate is greater than 10.3%. Application of pCND should be individualized based on risk of recurrence and added complications.
authors.forename: Kyle
authors.initials: K
authors.lastname: Zanocco
authors.forename: Dina
authors.initials: D
authors.lastname: Elaraj
authors.forename: Cord
authors.initials: C
authors.lastname: Sturgeon
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008390:Markov Chains; D037981:Neck Dissection / Q000009:adverse effects / Q000191:economics*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics