Cost Effectiveness of Definitive Treatment Strategies for Autonomously Functioning Thyroid Nodules

Area of Science:

• Endocrinology
• Medical Economics
• Health Services Research

Background:

• Autonomously functioning thyroid nodules (AFTN) present various treatment options including antithyroid drugs, radioactive iodine (RAI), thyroid lobectomy, and radiofrequency ablation (RFA).
• While surgery is definitive, it can lead to lifelong hormone supplementation, a sequela RFA aims to avoid, though its effectiveness is size-dependent.
• A comparative cost-effectiveness analysis is crucial for guiding treatment decisions for AFTN.

Purpose of the Study:

• To compare the relative cost-effectiveness of three primary treatment modalities for AFTN: RAI, RFA, and thyroid lobectomy.
• To evaluate clinical outcomes, costs, and quality-adjusted life years (QALYs) associated with each treatment.
• To inform clinical practice and healthcare policy regarding optimal AFTN management.

Main Methods:

• A Markov analysis model was developed to simulate patient pathways and outcomes over time.
• Data on transition probabilities, utilities, and costs were systematically extracted from published literature, Medicare databases, and RedBook.
• The model incorporated a willingness-to-pay threshold of $100,000 per QALY and underwent sensitivity analyses to assess the robustness of findings.

Main Results:

• In the base case analysis, RAI demonstrated cost-effectiveness dominance over both lobectomy and RFA, exhibiting lower costs and higher cumulative utility.
• Sensitivity analyses revealed that the cost-effectiveness comparison between surgery and RFA is sensitive to the probability of achieving euthyroidism post-RFA versus hypothyroidism post-lobectomy.
• RFA becomes more cost-effective than surgery if the euthyroidism rate after ablation exceeds 69%.

Conclusions:

• Radioactive iodine (RAI) emerges as the most cost-effective treatment for the majority of autonomously functioning thyroid nodules (AFTN) based on current data.
• Thyroid lobectomy is generally more cost-effective than RFA across most scenarios.
• Radiofrequency ablation (RFA) may offer a more resource-efficient alternative for smaller nodules where a high likelihood of complete treatment success can be achieved.