Cost-effectiveness of computed tomography nodal scan in patients with papillary thyroid carcinoma

Abstract

Objectives: This study evaluates the cost-effectiveness of ultrasound (US) only; computed tomography (CT) only; and combined US-CT in a base-case that underwent total thyroidectomy for a newly diagnosed papillary thyroid carcinoma (PTC) (scenario I) or surgery for recurrent disease (scenario II). Materials and methods: Markov chain model was developed comparing the above modalities. Follow-up time was set as 10 years. Costs and probabilities values are obtained from literature and the National Cancer Database. Results: Nodal mapping of the central compartment in both primary and recurrent PTC scenarios demonstrated combined utilization of preoperative US and CT is preferred over the use of US or CT separately; the final incurred management cost was [scenario I: U.S.$10,548.25 – scenario II: U.S.$11.197.88] and effectiveness was [scenario I: 6.875 Quality-adjusted-life-year (QALY) – scenario II: 6.871 QALY]. Nodal mapping of the lateral compartments favored US alone as the cost-effective modality in both scenarios; the final incurred management cost was [scenario I: U.S.$10,716.60 – scenario II: U.S.$11,247.92] and effectiveness was [scenario I: 6.879 QALY – scenario II: 6.883 QALY]. Sensitivity analysis demonstrated that for combined utilization of US and CT scans to remain cost-effective, the cost of a CT scan should be less than U.S.$1,127.54. Conclusions: Based on the model, combined utilization of US and CT is cost-effective in nodal mapping patients with PTC.