Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective

Area of Science:

• Endocrinology
• Surgical Oncology
• Health Economics

Background:

• The necessity of routine prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) is debated.
• This study assesses the cost-effectiveness of adding CND to total thyroidectomy (TT) for low-risk PTC.

Purpose of the Study:

• To evaluate the cost utility of routine prophylactic central neck dissection (CND) in addition to total thyroidectomy (TT) for low-risk papillary thyroid cancer (PTC).

Main Methods:

• A Markov model was developed for low-risk PTC based on American Thyroid Association guidelines.
• Cost data from US 2010 Medicare reimbursement rates and outcome probabilities from medical literature were utilized.
• Monte Carlo simulation and sensitivity analyses were performed to assess parameter uncertainty.

Main Results:

• Total thyroidectomy (TT) alone is more cost-effective than TT with CND, saving $5763 per patient and yielding $285 per QALY gained.
• Sensitivity analysis indicated TT alone is unfavorable if radioactive iodine (RAI) becomes more detrimental, non-neck recurrence exceeds 5% (TT alone), or permanent hypocalcemia exceeds 4%.

Conclusions:

• Routine prophylactic central neck dissection (CND) is not a cost-effective strategy for low-risk papillary thyroid cancer (PTC).
• Initial total thyroidectomy (TT) alone is favored due to low complication and recurrence rates.
• Further research is needed to determine the cost-effectiveness of alternative strategies like unilateral prophylactic neck dissection.