Thyroidectomy for euthyroid patients with Hashimoto thyroiditis and persisting symptoms: A cost-effectiveness...

Area of Science:

• Endocrinology
• Surgical Oncology
• Health Economics

Background:

• Persistent symptoms in euthyroid Hashimoto thyroiditis patients reduce quality of life despite hormone replacement.
• Total thyroidectomy shows promise in symptom improvement but carries a high complication rate.
• Evaluating the cost-effectiveness of total thyroidectomy is crucial for managing these patients.

Purpose of the Study:

• To assess the cost-effectiveness of total thyroidectomy versus medical therapy alone for euthyroid Hashimoto thyroiditis patients with persistent symptoms.

Main Methods:

• A lifetime Markov model compared total thyroidectomy and medical therapy.
• Cost, probability, and utility data were sourced from literature and Medicare.
• Sensitivity analyses were conducted to evaluate model uncertainty, using a $100,000/QALY willingness-to-pay threshold.

Main Results:

• Medical therapy alone cost $12,845 and yielded 16.9 QALYs, being a dominated strategy.
• Total thyroidectomy was less expensive by $1,490 and provided 1.4 additional QALYs.
• Sensitivity analyses indicated total thyroidectomy as optimal in 89% of simulations.

Conclusions:

• Total thyroidectomy is a more cost-effective strategy than medical therapy alone for managing persistent symptoms in euthyroid Hashimoto thyroiditis patients.
• Medical therapy only becomes cost-effective under specific adverse conditions for thyroidectomy.