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Article: A cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma

TitleA cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma
Authors
Issue Date2014
PublisherSpringer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org
Citation
Annals of Surgical Oncology, 2014, v. 21, n. 3, p. 767-777 How to Cite?
AbstractBackground: Although prophylactic central neck dissection (pCND) may reduce future locoregional recurrence after total thyroidectomy (TT) for low-risk papillary thyroid carcinoma (PTC), it is associated with a higher initial morbidity. We aimed to compare the long-term cost-effectiveness between TT with pCND (TT+pCND) and TT alone in the institution's perspective. Methods: Our case definition was a hypothetical cohort of 100,000 nonpregnant female patients aged 50 years with a 1.5-cm cN0 PTC within one lobe. A Markov decision tree model was constructed to compare the estimated cost-effectiveness between TT+pCND and TT alone after a 20-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000 per quality-adjusted life year (QALY). Sensitivity and threshold analyses were used to examine model uncertainty. Results: Each patient who underwent TT+pCND instead of TT alone cost an extra US$34.52 but gained an additional 0.323 QALY. In fact, in the sensitivity analysis, TT+pCND became cost-effective 9 years after the initial operation. In the threshold analysis, none of the scenarios that could change this conclusion appeared clinically possible or likely. However, TT+pCND became cost-saving (i.e., less costly and more cost-effective) at 20 years if associated permanent vocal cord palsy was kept ≤1.37 %, permanent hypoparathyroidism was ≤1.20 %, and/or postoperative radioiodine ablation use was ≤73.64 %. Conclusions: In the institution's perspective, routine pCND for low-risk PTC began to become cost-effective 9 years after initial surgery and became cost-saving at 20 years if postoperative radioiodine use and/or permanent surgical complications were kept to a minimum. © 2013 Society of Surgical Oncology.
Persistent Identifierhttp://hdl.handle.net/10722/202214
ISSN
2015 Impact Factor: 3.655
2015 SCImago Journal Rankings: 1.902

 

DC FieldValueLanguage
dc.contributor.authorWong, Carlos K. H.-
dc.contributor.authorLang, Brian-
dc.date.accessioned2014-08-22T02:57:49Z-
dc.date.available2014-08-22T02:57:49Z-
dc.date.issued2014-
dc.identifier.citationAnnals of Surgical Oncology, 2014, v. 21, n. 3, p. 767-777-
dc.identifier.issn1068-9265-
dc.identifier.urihttp://hdl.handle.net/10722/202214-
dc.description.abstractBackground: Although prophylactic central neck dissection (pCND) may reduce future locoregional recurrence after total thyroidectomy (TT) for low-risk papillary thyroid carcinoma (PTC), it is associated with a higher initial morbidity. We aimed to compare the long-term cost-effectiveness between TT with pCND (TT+pCND) and TT alone in the institution's perspective. Methods: Our case definition was a hypothetical cohort of 100,000 nonpregnant female patients aged 50 years with a 1.5-cm cN0 PTC within one lobe. A Markov decision tree model was constructed to compare the estimated cost-effectiveness between TT+pCND and TT alone after a 20-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000 per quality-adjusted life year (QALY). Sensitivity and threshold analyses were used to examine model uncertainty. Results: Each patient who underwent TT+pCND instead of TT alone cost an extra US$34.52 but gained an additional 0.323 QALY. In fact, in the sensitivity analysis, TT+pCND became cost-effective 9 years after the initial operation. In the threshold analysis, none of the scenarios that could change this conclusion appeared clinically possible or likely. However, TT+pCND became cost-saving (i.e., less costly and more cost-effective) at 20 years if associated permanent vocal cord palsy was kept ≤1.37 %, permanent hypoparathyroidism was ≤1.20 %, and/or postoperative radioiodine ablation use was ≤73.64 %. Conclusions: In the institution's perspective, routine pCND for low-risk PTC began to become cost-effective 9 years after initial surgery and became cost-saving at 20 years if postoperative radioiodine use and/or permanent surgical complications were kept to a minimum. © 2013 Society of Surgical Oncology.-
dc.languageeng-
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org-
dc.relation.ispartofAnnals of Surgical Oncology-
dc.rightsThe original publication is available at www.springerlink.com-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleA cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma-
dc.typeArticle-
dc.description.naturepostprint-
dc.identifier.doi10.1245/s10434-013-3398-3-
dc.identifier.pmid24276639-
dc.identifier.scopuseid_2-s2.0-84896710653-
dc.identifier.hkuros226993-
dc.identifier.volume21-
dc.identifier.issue3-
dc.identifier.spage767-
dc.identifier.epage777-
dc.identifier.eissn1534-4681-

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