title: Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer.
abstract: The management of low-risk micropapillary thyroid cancer <1 cm in size has come into question, because recent data have shown that nonoperative active surveillance of micropapillary thyroid cancer is a viable alternative to hemithyroidectomy. We conducted a cost-effectiveness analysis to help decide between observation versus operation.
  
  
  
  We constructed Markov models for active surveillance and hemithyroidectomy. The reference case was a 40-year-old patient with recently diagnosed, low-risk micropapillary thyroid cancer. Costs and health utilities were determined using extensive literature review. The willingness-to-pay threshold was set at $100,000/quality-adjusted life year gained. Deterministic and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables.
  
  
  
  Active surveillance is dominant (less expensive and more quality-adjusted life years) for a health utility <0.01 below that for disease-free, posthemithyroidectomy state, or for a remaining life expectancy of <2 years. For a utility difference ≥0.02, the incremental cost-effectiveness ratio (the ratio of the difference in costs between active surveillance and hemithyroidectomy divided by the difference in quality-adjusted life years) for hemithyroidectomy is <$100,000/QALY gained and thus cost-effective. For a utility difference of 0.11-the reference case scenario-the incremental cost-effectiveness ratio for hemithyroidectomy is $4,437/quality-adjusted life year gained.
  
  
  
  The cost-effectiveness of hemithyroidectomy is highly dependent on patient disutility associated with active surveillance. In patients who would associate nonoperative management with at least a modest decrement in quality of life, hemithyroidectomy is cost-effective.
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Shriya
authors.initials: S
authors.lastname: Venkatesh
authors.affiliation: Department of Surgery, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Pasternak
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Toni
authors.initials: T
authors.lastname: Beninato
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Frederick T
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Wouter P
authors.initials: WP
authors.lastname: Kluijfhout
authors.affiliation: Division of Endocrinology, Department of Medicine, University of California, San Francisco, CA.
authors.forename: Chienying
authors.initials: C
authors.lastname: Liu
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Gosnell
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA. Electronic address: insoo.suh@ucsf.edu.
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000191:economics / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics* / Q000379:methods; D057832:Watchful Waiting / Q000191:economics*