Treatment options for Graves disease: a cost-effectiveness analysis

Area of Science:

• Endocrinology
• Health Economics
• Surgical Outcomes

Background:

• Graves disease treatment often involves 18 months of antithyroid medication (ATM).
• Patients failing initial ATM require decisions on subsequent treatment: lifelong ATM, radioactive iodine (RAI), or total thyroidectomy (TT).
• Optimal cost-effectiveness of these second-line strategies remains debated.

Purpose of the Study:

• To conduct a formal cost-effectiveness analysis comparing RAI, lifelong ATM, and TT for Graves disease patients who do not achieve euthyroidism after initial ATM treatment.
• To identify the most economically viable treatment strategy from a healthcare system perspective.

Main Methods:

• A cost-effectiveness analysis was performed comparing TT, RAI, and lifelong ATM strategies.
• Data on treatment efficacy and complications were synthesized from a literature review.
• Costs were evaluated from a US healthcare system perspective using Medicare reimbursement rates, with outcomes measured in quality-adjusted life-years (QALYs).

Main Results:

• Total thyroidectomy (TT) emerged as the most cost-effective strategy, yielding 1.32 additional QALYs compared to RAI at an extra cost of $9,594 (ICER: $7,240/QALY).
• Radioactive iodine (RAI) was the least expensive ($23,600) but provided the fewest QALYs (25.08).
• Lifelong ATM becomes more cost-effective than TT if TT costs surpass $19,300, with an ICER of $15,000/QALY.

Conclusions:

• This study presents the first formal US cost-effectiveness analysis for second-line treatment in Graves disease patients failing initial ATM.
• Total thyroidectomy (TT) is demonstrably more cost-effective than RAI or lifelong ATM for this patient group.
• The cost-effectiveness advantage of TT persists until its price exceeds $19,300, after which lifelong ATM becomes superior.