Links for fulltext
(May Require Subscription)
- Publisher Website: 10.1245/s10434-013-3398-3
- Scopus: eid_2-s2.0-84896710653
- PMID: 24276639
- WOS: WOS:000334217300010
- Find via
Supplementary
- Citations:
- Appears in Collections:
Article: A cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma
Title | A cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma |
---|---|
Authors | |
Issue Date | 2014 |
Publisher | Springer 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? |
Abstract | Background: 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 Identifier | http://hdl.handle.net/10722/202214 |
ISSN | 2023 Impact Factor: 3.4 2023 SCImago Journal Rankings: 1.037 |
ISI Accession Number ID |
DC Field | Value | Language |
---|---|---|
dc.contributor.author | Wong, Carlos K. H. | - |
dc.contributor.author | Lang, Brian | - |
dc.date.accessioned | 2014-08-22T02:57:49Z | - |
dc.date.available | 2014-08-22T02:57:49Z | - |
dc.date.issued | 2014 | - |
dc.identifier.citation | Annals of Surgical Oncology, 2014, v. 21, n. 3, p. 767-777 | - |
dc.identifier.issn | 1068-9265 | - |
dc.identifier.uri | http://hdl.handle.net/10722/202214 | - |
dc.description.abstract | Background: 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.language | eng | - |
dc.publisher | Springer New York LLC. The Journal's web site is located at http://www.annalssurgicaloncology.org | - |
dc.relation.ispartof | Annals of Surgical Oncology | - |
dc.rights | The original publication is available at www.springerlink.com | - |
dc.title | A cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma | - |
dc.type | Article | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1245/s10434-013-3398-3 | - |
dc.identifier.pmid | 24276639 | - |
dc.identifier.scopus | eid_2-s2.0-84896710653 | - |
dc.identifier.hkuros | 226993 | - |
dc.identifier.volume | 21 | - |
dc.identifier.issue | 3 | - |
dc.identifier.spage | 767 | - |
dc.identifier.epage | 777 | - |
dc.identifier.eissn | 1534-4681 | - |
dc.identifier.isi | WOS:000334217300010 | - |
dc.identifier.issnl | 1068-9265 | - |