Cham Stephanie, Zanocco Kyle, Sturgeon Cord, Yeh Michael W, Harari Avital
1 Department of Surgery, Section of Endocrine Surgery, University of California , Los Angeles, Los Angeles, California.
Thyroid. 2014 Jun;24(6):975-86. doi: 10.1089/thy.2013.0470. Epub 2014 Mar 21.
A higher body mass index (BMI) is associated with more advanced stages of thyroid cancer. Screening obese patients for thyroid cancer has been proposed but has yet to be examined for cost-effectiveness. The objective of this study was to assess the cost-effectiveness of ultrasound (US) screening of obese patients for thyroid cancer.
A decision-tree model compared cost savings for the following: (i) base case scenario of an obese patient with thyroid nodule found by palpation, (ii) universal US screening of all obese patients, and (iii) risk-based US screening in obese patients. Risk-based screening consisted of patients who had at least one of four major identified risk factors for thyroid cancer (family history of thyroid cancer, radiation exposure, Hashimoto's thyroiditis, and/or elevated thyrotropin). Patients with nodules underwent established treatment and management guidelines. The model accounted for recurrence, complications, and long-term treatment/follow-up for five years. Outcome probabilities were identified from a literature review. Costs were estimated using a third-party payer perspective. Sensitivity analyses were performed to examine the impact of risk factor prevalence and US cost on the model.
The resulted costs per patient were $210.73 in the base case scenario, $434.10 in the universal US screening arm, and $166.72 in the risk-based screening arm. Risk-based screening remained cost-effective until more than 14% of obese patients had risk factors and with a wide variation of US costs ($0-$1113).
Risk-based US screening in selected obese patients with risk factors for thyroid cancer is cost-effective. Recommendations for screening this subgroup will result in cost savings and a likely decreased morbidity and mortality in this subpopulation with more aggressive disease.
较高的体重指数（BMI）与甲状腺癌的更晚期阶段相关。已有人提出对肥胖患者进行甲状腺癌筛查，但尚未对其成本效益进行评估。本研究的目的是评估对肥胖患者进行甲状腺癌超声（US）筛查的成本效益。
采用决策树模型比较以下各项的成本节约情况：（i）触诊发现甲状腺结节的肥胖患者的基础病例情景，（ii）对所有肥胖患者进行普遍US筛查，以及（iii）对肥胖患者进行基于风险的US筛查。基于风险的筛查包括具有四种已确定的甲状腺癌主要风险因素（甲状腺癌家族史、辐射暴露、桥本甲状腺炎和/或促甲状腺素升高）中至少一种的患者。有结节的患者接受既定的治疗和管理指南。该模型考虑了五年内的复发、并发症以及长期治疗/随访情况。通过文献综述确定结果概率。从第三方支付者的角度估计成本。进行敏感性分析以检查风险因素患病率和US成本对模型的影响。
基础病例情景下每位患者的成本为210.73美元，普遍US筛查组为434.10美元，基于风险的筛查组为166.72美元。在超过14%的肥胖患者有风险因素且US成本有广泛变化（0 - 1113美元）的情况下，基于风险的筛查仍具有成本效益。
对选定的有甲状腺癌风险因素的肥胖患者进行基于风险的US筛查具有成本效益。对该亚组进行筛查的建议将节省成本，并可能降低该疾病更具侵袭性的亚人群的发病率和死亡率。
