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Total Thyroidectomy for Cancer Gets Economic Nod

Procedure likely more cost-effective for low-risk papillary thyroid cancer than hemithyroidectomy

THURSDAY, Dec. 20 (HealthDay News) -- In patients with low-risk papillary thyroid cancer, treatment with total thyroidectomy is probably a more cost-effective initial surgical treatment than hemithyroidectomy, though some caveats apply, according to research published in the December issue of the Archives of Otolaryngology -- Head & Neck Surgery.

Mark G. Shrime, M.D., of the University of Toronto Health Network in Ontario, Canada, and colleagues analyzed combined data from 31 studies on surgical treatments for low-risk thyroid carcinoma. The authors modeled surgical management outcomes and performed a cost-effectiveness analysis using fixed probability estimates and Monte Carlo microsimulation.

Over 20 years, cost estimates for total thyroidectomy, including follow-up and treatment of recurrence, were between $13,896 and $14,241. For hemithyroidectomy, they were between $15,037 and $15,063. Recurrence-free survival was higher in the total thyroidectomy group. However, treatment outcomes varied by institution, which may reflect differences in populations, follow-up strategies, local expertise or the definition of recurrence. Also, use of radioactive iodine and recombinant human thyrotropin could tilt the preference toward hemithyroidectomy.

"For a patient with low-risk papillary thyroid carcinoma, total thyroidectomy likely represents the most cost-effective initial surgical management, although this may be institution dependent. This recommendation is sensitive to rates of recurrence but remains robust compared with willingness-to-pay calculations. The routine use of recombinant human thyrotropin may alter recommendations in favor of hemithyroidectomy. Prospective clinical studies are warranted to validate these findings," the authors conclude.

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