Total Thyroidectomy Versus Lobectomy in Small Nodules Suspicious for Papillary Thyroid Cancer: Cost‐Effectiveness Analysis

Total Thyroidectomy Versus Lobectomy in Small Nodules Suspicious for Papillary Thyroid Cancer: Cost‐Effectiveness Analysis:

Objectives/Hypothesis

Recent American Thyroid Association Guidelines recommend either near‐total/total thyroidectomy or lobectomy for patients with a thyroid nodule suspicious for papillary thyroid cancer (PTC) on fine‐needle aspiration (FNA) biopsy (Bethesda V). In this analysis, we aim to assess the cost‐effectiveness of lobectomy in comparison to total thyroidectomy.

Study Design

Cost‐effectiveness analysis.

Methods

A Markov model cost‐effectiveness analysis was performed for a base case followed for 20 years postoperatively. Cost and probabilities data were retrieved from the current literature. Effectiveness was represented by quality‐adjusted life year (QALY).

Results

Total thyroidectomy protocol produced an incremental cost of $2,681.36 and incremental effectiveness of −0.24 QALY as compared to lobectomy protocol (incremental cost‐effectiveness ratio [ICER] = −$11,188.85/QALY). Sensitivity analysis demonstrated that total thyroidectomy becomes a cost‐effective strategy only if the risk of stages III and IV PTC is 82.4% among patients with suspicious PTC on preoperative FNA. Lobectomy is cost effective and preferred over total thyroidectomy as long as lobectomy complications are less than 50%.

Conclusions

Total thyroidectomy is not just cost prohibitive but also associated with a lower effectiveness compared to lobectomy.

Level of Evidence

2c Laryngoscope, 2020