Is subtotal thyroidectomy a cost-effective treatment for Graves disease? A cost-effectiveness analysis of the medical and surgical treatment options

  • K. Z
  • M. H
  • D. E
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Abstract

Background: The 3 treatment options for Graves disease (GD) are antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroid surgery. We hypothesized that thyroid surgery is cost-effective for Graves disease when compared to RAI or ATD. Methods: Cost-effectiveness analysis was performed to compare operative strategies to medical treatment strategies for GD. The decision model, based on a reference case, included treatment outcomes, probabilities, and costs derived from literature review. Outcomes were weighted using quality of life utility factors, yielding quality-adjusted life years (QALYs). The uncertainty of costs, probabilities, and utility estimates in the model were examined by univariate and multivariate sensitivity analysis and Monte Carlo simulation. Results: The subtotal thyroidectomy strategy produced the greatest QALYs, 25.783, with an incremental cost-effectiveness ratio of $26,602 per QALY, reflecting a gain of 0.091 QALYs at an additional cost of $2416 compared to RAI. Surgery was cost-effective when the initial postoperative euthyroid rate was greater than 49.5% and the total cost was less than $7391. Monte Carlo simulation showed the subtotal thyroidectomy strategy to be optimal in 826 of 1000 cases. Conclusion: This study demonstrates that subtotal thyroidectomy can be a cost-effective treatment for GD. However, a 49.5% initial postoperative euthyroid rate was a necessary condition for cost-effective surgical management of GD. © 2012 Mosby, Inc. All rights reserved.

Author-supplied keywords

  • *Graves disease/dm [Disease Management]
  • *Graves disease/dt [Drug Therapy]
  • *Graves disease/su [Surgery]
  • *subtotal thyroidectomy
  • Graves disease/dt [Drug Therapy]
  • Monte Carlo method
  • cost effectiveness analysis
  • endocrine ophthalmopathy/co [Complication]
  • endocrine ophthalmopathy/si [Side Effect]
  • euthyroidism
  • human
  • hypoparathyroidism/co [Complication]
  • laryngeal nerve injury/co [Complication]
  • outcome assessment
  • priority journal
  • quality adjusted life year
  • quality of life
  • radioactive iodine/ae [Adverse Drug Reaction]
  • radioactive iodine/dt [Drug Therapy]
  • review
  • sensitivity analysis
  • thionamide/ae [Adverse Drug Reaction]
  • thionamide/dt [Drug Therapy] XT - endocrine ophth
  • thyroidectomy

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Authors

  • Zanocco K.

  • Heller M.

  • Elaraj D.

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