Thyroid lobectomy as a cost-effective approach in low-risk papillary thyroid cancer versus active surveillance

Background: An ongoing debate exists over the optimal management of low-risk papillary thyroid cancer. The American Thyroid Association supports the concept of active surveillance to manage low-risk papillary thyroid cancer; however, the cost-effectiveness of active surveillance has not yet been estab- lished. We sought to perform a cost-effectiveness analysis comparing active surveillance versus surgical intervention for patients in the United States. Methods: A Markov decision tree model was developed to compare active surveillance and thyroid lo- bectomy. Our reference case is a 40-year-old female who was diagnosed with unifocal (<15 mm), low- risk papillary thyroid cancer. Probabilistic outcomes, costs, and health utilities were determined using an extensive literature review. The willingness-to-pay threshold was set at $50,000/quality-adjusted life year gained. Sensitivity analyses were performed to account for uncertainty in the model's variables. Results: Lobectomy provided a final effectiveness of 21.7/quality-adjusted life years, compared with 17.3/ quality-adjusted life years for active surveillance. Furthermore, incremental cost effectiveness ratio for lobectomy versus active surveillance was $19,560/quality-adjusted life year ( Conclusion: Lobectomy is a cost-effective strategy in middle-aged patients with low-risk papillary thy- roid cancer. In contrast, active surveillance is cost-effective beginning at the age of 69. Identification of such nuances can help physicians and patients determine the best, most individualized long-term management strategy for low-risk papillary thyroid cancer. Published by Elsevier Inc.