| Title |
Lobectomy is a more Cost-Effective Option than Total Thyroidectomy for 1 to 4 cm Papillary Thyroid Carcinoma that do not Possess Clinically Recognizable High-Risk Features
|
|---|---|
| Published in |
Annals of Surgical Oncology, May 2016
|
| DOI | 10.1245/s10434-016-5280-6 |
| Pubmed ID | |
| Authors |
Brian Hung-Hin Lang, Carlos K. H. Wong |
| Abstract |
Although lobectomy is a viable alternative to total thyroidectomy (TT) in low-risk 1 to 4 cm papillary thyroid carcinoma (PTC), lobectomy is associated with higher locoregional recurrence risk and need for completion TT upon discovery of a previously unrecognized histologic high-risk feature (HRF). The present study evaluated long-term cost-effectiveness between lobectomy and TT. Our base case was a hypothetical female cohort aged 40 years with a low-risk 2.5 cm PTC. A Markov decision tree model was constructed to compare cost-effectiveness between lobectomy and TT after 25 years. Patients with an unrecognized HRF (including aggressive histology, microscopic extrathyroidal extension, lymphovascular invasion, positive resection margin, nodal metastasis >5 mm, and multifocality) underwent completion TT after lobectomy. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year (QALY). Sensitivity and threshold analyses were used to examine model uncertainty. After 25 years, each patient who underwent lobectomy instead of TT cost an extra US$772.08 but gained an additional 0.300 QALY. The incremental cost-effectiveness ratio was US$2577.65/QALY. In the sensitivity analysis, the lobectomy arm began to become cost-effective only after 3 years. Despite varying the reported prevalence of clinically unrecognized HRFs, complication from surgical procedures, annualized recurrence rates, unit cost of surgical procedure or complication, and utility score, lobectomy remained more cost-effective than TT. Despite the higher locoregional recurrence risk and having almost half of the patients undergoing completion TT after lobectomy upon discovery of a previously unrecognized HRF, initial lobectomy was a more cost-effective long-term option than initial TT for 1 to 4 cm PTCs without clinically recognized HRFs. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Hong Kong | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 34 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 34 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 5 | 15% |
| Student > Bachelor | 5 | 15% |
| Student > Master | 4 | 12% |
| Professor > Associate Professor | 3 | 9% |
| Professor | 3 | 9% |
| Other | 6 | 18% |
| Unknown | 8 | 24% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 17 | 50% |
| Nursing and Health Professions | 2 | 6% |
| Agricultural and Biological Sciences | 2 | 6% |
| Biochemistry, Genetics and Molecular Biology | 1 | 3% |
| Economics, Econometrics and Finance | 1 | 3% |
| Other | 1 | 3% |
| Unknown | 10 | 29% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 06 September 2016.
All research outputs
#15,383,207
of 22,886,568 outputs
Outputs from Annals of Surgical Oncology
#4,402
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Outputs of similar age
#208,139
of 334,093 outputs
Outputs of similar age from Annals of Surgical Oncology
#91
of 131 outputs
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