TY - JOUR
T1 - Routine prophylactic central neck dissection for low-risk papillary thyroid cancer
T2 - A cost-effectiveness analysis
AU - Zanocco, Kyle
AU - Elaraj, Dina
AU - Sturgeon, Cord
N1 - Funding Information:
Kyle Zanocco’s participation in this study was supported in part by the Northwestern University Feinberg School of Medicine Center for Healthcare Studies under an institutional award from the Agency for Healthcare Research and Quality, T-32 HS 000078 (PI: Jane L. Holl, MD, MPH).
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2013/12
Y1 - 2013/12
N2 - Background Routine prophylactic central neck dissection (pCND) after total thyroidectomy (TTX) for low-risk papillary thyroid cancer (PTC) offers the potential to decrease disease recurrence but may increase operative complications. We hypothesized that routine pCND is not cost-effective in low-risk PTC. Methods A Markov transition-state model was constructed to compare TTX with and without pCND. Outcome probabilities, utilities, and costs were estimated on the basis of literature review. The threshold for cost-effectiveness was $100,000 per quality-adjusted life year. Sensitivity analysis was used to examine model uncertainty. Results pCND cost $10,315 and produced an effectiveness of 23.785 quality-adjusted life years. This strategy was more costly and less effective than TTX without pCND and was therefore dominated. pCND became cost-effective when the probability of recurrence increased from 6% to 10.3%, cost of reoperation for recurrence increased from $8,900 to $26,120, or added probabilities of recurrent laryngeal nerve injury and hypoparathyroidism due to pCND were less than 0.20% and 0.18% during 2-way sensitivity analysis. Monte Carlo simulation showed that pCND was not cost-effective in 97.3% of iterations. Conclusion Routine pCND for low-risk PTC is not cost-effective unless the recurrence rate is greater than 10.3%. Application of pCND should be individualized based on risk of recurrence and added complications.
AB - Background Routine prophylactic central neck dissection (pCND) after total thyroidectomy (TTX) for low-risk papillary thyroid cancer (PTC) offers the potential to decrease disease recurrence but may increase operative complications. We hypothesized that routine pCND is not cost-effective in low-risk PTC. Methods A Markov transition-state model was constructed to compare TTX with and without pCND. Outcome probabilities, utilities, and costs were estimated on the basis of literature review. The threshold for cost-effectiveness was $100,000 per quality-adjusted life year. Sensitivity analysis was used to examine model uncertainty. Results pCND cost $10,315 and produced an effectiveness of 23.785 quality-adjusted life years. This strategy was more costly and less effective than TTX without pCND and was therefore dominated. pCND became cost-effective when the probability of recurrence increased from 6% to 10.3%, cost of reoperation for recurrence increased from $8,900 to $26,120, or added probabilities of recurrent laryngeal nerve injury and hypoparathyroidism due to pCND were less than 0.20% and 0.18% during 2-way sensitivity analysis. Monte Carlo simulation showed that pCND was not cost-effective in 97.3% of iterations. Conclusion Routine pCND for low-risk PTC is not cost-effective unless the recurrence rate is greater than 10.3%. Application of pCND should be individualized based on risk of recurrence and added complications.
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U2 - 10.1016/j.surg.2013.06.016
DO - 10.1016/j.surg.2013.06.016
M3 - Article
C2 - 24383082
AN - SCOPUS:84887865328
VL - 154
SP - 1148
EP - 1155
JO - Surgery
JF - Surgery
SN - 0039-6060
IS - 6
ER -
