Total Thyroidectomy Versus Lobectomy in Small Nodules Suspicious for Papillary Thyroid Cancer: Cost-Effectiveness Analysis

Abstract

Objectives/Hypothesis: Recent American Thyroid Association Guidelines recommend either near-total/total thyroidectomy or lobectomy for patients with a thyroid nodule suspicious for papillary thyroid cancer (PTC) on fine-needle aspiration (FNA) biopsy (Bethesda V). In this analysis, we aim to assess the cost-effectiveness of lobectomy in comparison to total thyroidectomy. Study Design: Cost-effectiveness analysis. Methods: A Markov model cost-effectiveness analysis was performed for a base case followed for 20 years postoperatively. Cost and probabilities data were retrieved from the current literature. Effectiveness was represented by quality-adjusted life year (QALY). Results: Total thyroidectomy protocol produced an incremental cost of $2,681.36 and incremental effectiveness of −0.24 QALY as compared to lobectomy protocol (incremental cost-effectiveness ratio [ICER] = −$11,188.85/QALY). Sensitivity analysis demonstrated that total thyroidectomy becomes a cost-effective strategy only if the risk of stages III and IV PTC is 82.4% among patients with suspicious PTC on preoperative FNA. Lobectomy is cost effective and preferred over total thyroidectomy as long as lobectomy complications are less than 50%. Conclusions: Total thyroidectomy is not just cost prohibitive but also associated with a lower effectiveness compared to lobectomy. Level of Evidence: 2c Laryngoscope, 2020.