In Haejin, Pearce Elizabeth N, Wong Arthur K, Burgess James F, McAneny David B, Rosen Jennifer E
Department of Surgery, Boston Medical Center, 88 East Newton St, #C515, Boston, MA 02118, USA.
J Am Coll Surg. 2009 Aug;209(2):170-179.e1-2. doi: 10.1016/j.jamcollsurg.2009.03.025. Epub 2009 May 28.
First-line treatment for Graves disease is frequently 18 months of antithyroid medication (ATM). Controversy exists concerning the next best line of treatment for patients who have failed to achieve euthyroidism; options include lifelong ATM, radioactive iodine (RAI), or total thyroidectomy (TT). We aim to determine the most cost-effective option.
We performed a cost-effectiveness analysis comparing these different strategies. Treatment efficacy and complication data were derived from a literature review. Costs were examined from a health-care system perspective using actual Medicare reimbursement rates to an urban university hospital. Outcomes were measured in quality-adjusted life-years (QALY). Costs and effectiveness were converted to present values; all key variables were subjected to sensitivity analysis.
TT was the most cost-effective strategy, resulting in a gain of 1.32 QALYs compared with RAI (at an additional cost of 9,594 US dollars) and an incremental cost-effectiveness ratio of 7,240 US dollars/QALY. RAI was the least costly option at 23,600 US dollars but also provided the least QALY (25.08 QALY). Once the cost of TT exceeds 19,300 US dollars, the incremental cost-effectiveness ratio of lifelong ATM and TT reverse and lifelong ATM becomes the more cost-effective strategy at 15,000US dollars/QALY.
This is the first formal cost-effectiveness study in the US of the optimal treatment for patients with Graves disease who fail to achieve euthyroidism after 18 months of ATM. Our findings demonstrate that TT is more cost effective than RAI or lifelong ATM in these patients; this continues until the cost of TT becomes > 19,300 US dollars.
格雷夫斯病的一线治疗通常是18个月的抗甲状腺药物治疗（ATM）。对于未能实现甲状腺功能正常的患者，下一个最佳治疗方案存在争议；选择包括终身ATM、放射性碘（RAI）或全甲状腺切除术（TT）。我们旨在确定最具成本效益的选择。
我们进行了一项成本效益分析，比较了这些不同的策略。治疗效果和并发症数据来自文献综述。从医疗保健系统的角度，使用向城市大学医院实际支付的医疗保险报销率来检查成本。结果以质量调整生命年（QALY）衡量。成本和效果转换为现值；所有关键变量都进行了敏感性分析。
TT是最具成本效益的策略，与RAI相比可获得1.32个QALY（额外成本为9594美元），增量成本效益比为7240美元/QALY。RAI是成本最低的选择，为23600美元，但提供的QALY也最少（25.08个QALY）。一旦TT的成本超过19300美元，终身ATM和TT的增量成本效益比就会反转，终身ATM在15000美元/QALY时成为更具成本效益的策略。
这是美国首次对接受18个月ATM治疗后未能实现甲状腺功能正常的格雷夫斯病患者的最佳治疗进行正式的成本效益研究。我们的研究结果表明，在这些患者中，TT比RAI或终身ATM更具成本效益；这种情况一直持续到TT的成本超过19300美元。
