Al-Qurayshi Zaid, Farag Mahmoud, Shama Mohamed A, Ibraheem Kareem, Randolph Gregory W, Kandil Emad
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.
Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
Laryngoscope. 2020 Dec;130(12):2922-2926. doi: 10.1002/lary.28634. Epub 2020 Apr 2.
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.
Cost-effectiveness analysis.
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).
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%.
Total thyroidectomy is not just cost prohibitive but also associated with a lower effectiveness compared to lobectomy.
2c Laryngoscope, 2020.
目的/假设：美国甲状腺协会近期发布的指南建议，对于细针穿刺活检（FNA）提示可疑甲状腺乳头状癌（PTC）的甲状腺结节患者（贝塞斯达Ⅴ类），可选择近全/全甲状腺切除术或甲状腺叶切除术。在本分析中，我们旨在评估甲状腺叶切除术与全甲状腺切除术相比的成本效益。
成本效益分析。
对术后随访20年的基础病例进行马尔可夫模型成本效益分析。成本和概率数据取自当前文献。有效性以质量调整生命年（QALY）表示。
与甲状腺叶切除术方案相比，全甲状腺切除术方案产生的增量成本为2681.36美元，增量有效性为-0.24 QALY（增量成本效益比[ICER]=-11188.85美元/QALY）。敏感性分析表明，只有当术前FNA提示可疑PTC的患者中Ⅲ期和Ⅳ期PTC的风险为82.4%时，全甲状腺切除术才成为具有成本效益的策略。只要甲状腺叶切除术并发症少于50%，甲状腺叶切除术就具有成本效益且优于全甲状腺切除术。
全甲状腺切除术不仅成本高昂，而且与甲状腺叶切除术相比有效性更低。
2c《喉镜》，2020年
