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Routine prophylactic central neck dissection for low-risk papillary thyroid cancer: a cost-effectiveness analysis
Surgery
|January 3, 2014
Summary
Routine prophylactic central neck dissection (pCND) for low-risk papillary thyroid cancer (PTC) is not cost-effective. Individualizing pCND based on recurrence risk and potential complications is recommended for better patient outcomes.
Area of Science:
- Endocrinology
- Surgical Oncology
- Health Economics
Background:
- Papillary thyroid cancer (PTC) is a common endocrine malignancy.
- Total thyroidectomy (TTX) is a standard treatment for PTC.
- Prophylactic central neck dissection (pCND) is debated for low-risk PTC due to potential complications versus recurrence reduction.
Purpose of the Study:
- To evaluate the cost-effectiveness of routine prophylactic central neck dissection (pCND) versus TTX alone for low-risk papillary thyroid cancer (PTC).
Main Methods:
- A Markov transition-state model was developed to compare TTX with and without pCND.
- Outcome probabilities, utilities, and costs were derived from literature review.
- Cost-effectiveness threshold set at $100,000 per quality-adjusted life year (QALY).
Main Results:
- Routine pCND incurred an additional cost of $10,315 and yielded 23.785 QALYs, proving less effective and more costly than TTX alone.
- pCND was only cost-effective if recurrence probability exceeded 10.3% or reoperation costs significantly increased.
- Monte Carlo simulations indicated pCND was not cost-effective in 97.3% of analyses.
Conclusions:
- Routine pCND is not a cost-effective strategy for low-risk PTC.
- Individualized application of pCND is warranted, considering patient-specific recurrence risk and potential surgical morbidities.
