Section of Endocrine Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Surgery. 2012 Aug;152(2):164-72. doi: 10.1016/j.surg.2012.02.020. Epub 2012 Apr 12.
The 3 treatment options for Graves disease (GD) are antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroid surgery. We hypothesized that thyroid surgery is cost-effective for Graves disease when compared to RAI or ATD.
Cost-effectiveness analysis was performed to compare operative strategies to medical treatment strategies for GD. The decision model, based on a reference case, included treatment outcomes, probabilities, and costs derived from literature review. Outcomes were weighted using quality of life utility factors, yielding quality-adjusted life years (QALYs). The uncertainty of costs, probabilities, and utility estimates in the model were examined by univariate and multivariate sensitivity analysis and Monte Carlo simulation.
The subtotal thyroidectomy strategy produced the greatest QALYs, 25.783, with an incremental cost-effectiveness ratio of $26,602 per QALY, reflecting a gain of 0.091 QALYs at an additional cost of $2416 compared to RAI. Surgery was cost-effective when the initial postoperative euthyroid rate was greater than 49.5% and the total cost was less than $7391. Monte Carlo simulation showed the subtotal thyroidectomy strategy to be optimal in 826 of 1000 cases.
This study demonstrates that subtotal thyroidectomy can be a cost-effective treatment for GD. However, a 49.5% initial postoperative euthyroid rate was a necessary condition for cost-effective surgical management of GD.
格雷夫斯病（GD）的 3 种治疗选择是抗甲状腺药物（ATD）、放射性碘（RAI）和甲状腺手术。我们假设与 RAI 或 ATD 相比，甲状腺手术对于 GD 是具有成本效益的。
进行了成本效益分析，以比较 GD 的手术策略与药物治疗策略。该决策模型基于参考病例，包括来自文献回顾的治疗结果、概率和成本。使用生活质量效用因素对结果进行加权，得出质量调整生命年（QALY）。通过单变量和多变量敏感性分析以及蒙特卡罗模拟检查模型中成本、概率和效用估计的不确定性。
甲状腺次全切除术策略产生的 QALY 最多，为 25.783，增量成本效益比为每 QALY 26602 美元，反映与 RAI 相比，在增加 2416 美元的额外成本下，增加了 0.091 QALY。当术后初始甲状腺功能正常率大于 49.5%且总费用小于 7391 美元时，手术具有成本效益。蒙特卡罗模拟显示，甲状腺次全切除术策略在 1000 例中有 826 例是最优的。
本研究表明，甲状腺次全切除术可以成为 GD 的一种具有成本效益的治疗方法。然而，术后初始甲状腺功能正常率为 49.5%是 GD 手术管理具有成本效益的必要条件。
