title: Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.
abstract: OBJECTIVE
  Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia.
  
  
  METHODS
  We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD).
  
  
  RESULTS
  RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD.
  
  
  CONCLUSIONS
  In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies.
authors.affiliation: Department of Clinical PharmacologyRoyal Brisbane and Women's Hospital, Herston, Queensland, Australia peter.donovan@health.qld.gov.au.|School of Medicine and BiosciencesUniversity of Queensland, Herston, Queensland, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Donovan
authors.affiliation: School of Medicine and BiosciencesUniversity of Queensland, Herston, Queensland, Australia.|Department of Endocrinology and DiabetesRoyal Brisbane and Women's Hospital, Herston, Queensland, Australia.|Population Health DepartmentQIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
authors.forename: Donald S A
authors.initials: DS
authors.lastname: McLeod
authors.affiliation: Consultant Health EconomistCambridge, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Little
authors.affiliation: Population Health DepartmentQIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.|Centre for Applied Health EconomicsLogan Campus, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Gordon
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000191:economics* / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000379:methods; D004739:England / Q000453:epidemiology; D005260:Female; D006111:Graves Disease / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000191:economics* / Q000627:therapeutic use; D013965:Thyroidectomy / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes