Cost-effectiveness analysis of papillary thyroid cancer surveillance.
BACKGROUND
The recent overdiagnosis of subclinical, low-risk papillary thyroid cancer (PTC) coincides with a growing national interest in cost-effective health care practices. The aim of this study was to measure the relative cost-effectiveness of disease surveillance of low-risk PTC patients versus intermediate- and high-risk patients in accordance with American Thyroid Association risk categories.


METHODS
Two thousand nine hundred thirty-two patients who underwent thyroidectomy for differentiated thyroid cancer between 2000 and 2010 were identified from the institutional database; 1845 patients were excluded because they had non-PTC cancer, underwent less than total thyroidectomy, had a secondary cancer, or had <36 months of follow-up. In total, 1087 were included for analysis. The numbers of postoperative blood tests, imaging scans and biopsies, clinician office visits, and recurrence events were recorded for the first 36 months of follow-up. Costs of surveillance were determined with the Physician Fee Schedule and Clinical Lab Fee Schedule of the Centers for Medicare and Medicaid Services.


RESULTS
The median age was 44 years (range, 7-83 years). In the first 36 months after thyroidectomy, there were 3, 44, and 22 recurrences (0.8%, 7.8%, and 13.4%) in the low-, intermediate-, and high-risk categories, respectively. The cost of surveillance for each recurrence detected was US $147,819, US $22,434, and US $20,680, respectively.


CONCLUSIONS
The cost to detect a recurrence in a low-risk patient is more than 6 and 7 times greater than the cost for intermediate- and high-risk PTC patients. It is difficult to justify this allocation of resources to the surveillance of low-risk patients. Surveillance strategies for the low-risk group should, therefore, be restructured.
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Laura Y
LY
Wang
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Benjamin R
BR
Roman
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Jocelyn C
JC
Migliacci
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Frank L
FL
Palmer
Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
R Michael
RM
Tuttle
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Ashok R
AR
Shaha
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Jatin P
JP
Shah
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Snehal G
SG
Patel
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Ian
I
Ganly
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000191:economics* / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary; D002648:Child; D003362:Cost-Benefit Analysis; D006403:Hematologic Tests / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000191:economics* / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
cost-effectiveness analysis; epidemiology; recurrence; thyroid neoplasm; ultrasonography