title: Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis.
abstract: BACKGROUND
  Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs.
  
  
  METHODS
  A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed.
  
  
  RESULTS
  In a deterministic analysis, the cost, utility and cost-utility ratio was COP $12.981.801, 44.5 and COP $291.310 for total thyroidectomy and COP $14.309.889, 42.0 and $340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -$535.302 favoring total thyroidectomy. Partial thyroidectomy was more cost-effective when the risks of RLN injury and definitive hypoparathyroidism were greater than 8% and 9% in total thyroidectomy, respectively. In total, 46.8% of the simulations for partial thyroidectomy were located in the quadrant of more costly and less effective.
  
  
  CONCLUSIONS
  Under a common range of complications, and considering the patient's preference and costs, total thyroidectomy should be selected as the most cost-effective treatment for patients with thyroid nodules and follicular patterns.
authors.affiliation: Department of Surgery, Universidad de La Sabana, Chia, Colombia.
authors.forename: C
authors.initials: C
authors.lastname: Corso
authors.affiliation: Education and Research Division, Fundacion Abood Shaio, Bogota, Colombia.
authors.forename: X
authors.initials: X
authors.lastname: Gomez
authors.affiliation: Department of Surgery, Universidad de La Sabana, Chia, Colombia; Oncology Unit, Hospital Pablo Tobon Uribe, Department of Surgery, Universidad de Antioquia, Medellin, Colombia. Electronic address: alvaro.sanabria@unisabana.edu.co.
authors.forename: A
authors.initials: A
authors.lastname: Sanabria
authors.affiliation: Department of Surgery, Universidad de La Sabana, Chia, Colombia.
authors.forename: V
authors.initials: V
authors.lastname: Vega
authors.affiliation: Department of Surgery, Universidad de La Sabana, Chia, Colombia.
authors.forename: L C
authors.initials: LC
authors.lastname: Dominguez
authors.affiliation: Department of Surgery, Universidad de La Sabana, Chia, Colombia.
authors.forename: C
authors.initials: C
authors.lastname: Osorio
mesh_terms: D003105:Colombia; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D012086:Reoperation; D013964:Thyroid Neoplasms / Q000601:surgery*; D016606:Thyroid Nodule / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods
keywords: Cost-benefit; Goiter; Thyroid cancer; Thyroidectomy