Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Otolaryngol Head Neck Surg. 2021 Jun;164(6):1172-1178. doi: 10.1177/0194599820966982. Epub 2020 Oct 20.
To perform a comparative analysis of postthyroidectomy radioactive iodine ablation dosing with or without the implementation of a diagnostic whole-body scan in patients with well-differentiated thyroid cancer.
Decision analysis model.
Hospital or ambulatory center.
A decision tree model was created to determine the cost-effectiveness of radioactive iodine ablation dosed with diagnostic whole-body scans versus empiric radioactive iodine ablation in patients with differentiated thyroid cancer undergoing postthyroidectomy ablation. The decision tree was populated with values from the published literature. Costs were represented by 2020 Medicare reimbursement rates (US dollars), and morbidity and survival data were used to calculate quality-adjusted life-years. The incremental cost-effectiveness ratio was the primary outcome.
Empiric radioactive iodine dosing was the dominant economic strategy, producing 0.94 more quality-adjusted life-years while costing $1250.07 less than management with a diagnostic whole-body scan. Sensitivity analyses upheld these results except in cases involving a large discrepancy in successful ablation rates between the diagnostic and empiric treatment arms.
For patients with differentiated thyroid cancer requiring postthyroidectomy ablation, it is more cost-effective to administer radioactive iodine empirically.
对分化型甲状腺癌患者行甲状腺切除术后放射性碘消融时，实施或不实施诊断性全身扫描，进行放射性碘消融剂量的比较分析。
决策分析模型。
医院或门诊中心。
创建决策树模型，以确定在接受甲状腺切除术后消融的分化型甲状腺癌患者中，与诊断性全身扫描相比，放射性碘消融的经验性剂量是否具有成本效益。决策树采用来自已发表文献中的数值填充。成本用 2020 年医疗保险报销率（美元）表示，发病率和生存率数据用于计算质量调整生命年。增量成本效益比是主要的结果。
经验性放射性碘给药是具有优势的经济策略，产生 0.94 个更多的质量调整生命年，而成本比诊断性全身扫描管理低 1250.07 美元。敏感性分析支持这些结果，但在诊断性治疗组和经验性治疗组之间的成功消融率存在较大差异的情况下除外。
对于需要甲状腺切除术后消融的分化型甲状腺癌患者，经验性给予放射性碘更具成本效益。
