Cost–utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves’ disease

Peter J Donovan, Donald S A McLeod, Richard Little, Louisa Gordon

Little data exists about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine [RAI]; antithyroid drugs [ATD]); and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality adjusted life-years [QALYs]). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5,425; QALYs 34.73) and Australia (AUD5,601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16,866; 35.17 QALYs; incremental cost-effectiveness ratio [ICER] £26,279 per QALY gained England; AUD8,924; 31.37 QALYs; ICER AUD9,687 per QALY gained Australia), while RAI dominated TT (£7,115; QALYs 33.93 England; AUD15,668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality of life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies.