Routine prophylactic central neck dissection for low-risk papillary thyroid cancer

A cost-effectiveness analysis

Kyle Zanocco, Dina M Elaraj, Cord Sturgeon*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1148-1155
Number of pages8
JournalSurgery (United States)
Volume154
Issue number6
DOIs
StatePublished - Dec 1 2013

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Neck Dissection
Cost-Benefit Analysis
Costs and Cost Analysis
Recurrence
Quality-Adjusted Life Years
Recurrent Laryngeal Nerve Injuries
Papillary Thyroid cancer
Hypoparathyroidism
Thyroidectomy
Reoperation
Uncertainty

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Routine prophylactic central neck dissection for low-risk papillary thyroid cancer: A cost-effectiveness analysis",
abstract = "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.",
author = "Kyle Zanocco and Elaraj, {Dina M} and Cord Sturgeon",
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Routine prophylactic central neck dissection for low-risk papillary thyroid cancer : A cost-effectiveness analysis. / Zanocco, Kyle; Elaraj, Dina M; Sturgeon, Cord.

In: Surgery (United States), Vol. 154, No. 6, 01.12.2013, p. 1148-1155.

Research output: Contribution to journalArticle

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 M

AU - Sturgeon, Cord

PY - 2013/12/1

Y1 - 2013/12/1

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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