Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Korean Med Sci. 2023 Aug 28;38(34):e264. doi: 10.3346/jkms.2023.38.e264.
Recently, active surveillance (AS) has been introduced as an alternative to early surgery (ES) for the management of papillary thyroid microcarcinoma (PTMC), because of its indolent features and low mortality. However, its cost effects have not been determined and the findings of current studies differ, according to each country's medical system.
A Markov model was constructed to compare the cost-effectiveness of AS and ES, based on a reference case of a 40-year-old patient diagnosed with PTMC. Costs and transition probabilities were derived from previous clinical studies in Korean populations, and the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated. The willingness-to-pay (WTP) threshold was set at USD 100,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address the uncertainties in the model's variables.
From the base scenario, the cumulative costs and effectiveness were both higher in ES than AS. The ICER for ES, compared with AS, was USD 6,619.86/QALY, lower than the set WTP. The NMB difference between AS and ES increased across the stages (USD 5,980 at the first stage and USD 159,667 at the last stage). The ICER increased along with decreasing age and increasing cost of surgery. The higher the ES utility score and the lower that of AS, the more cost-effective ES, with WTP set at USD 30,000.
In the current Korean medical system, ES is more cost-effective than AS. ES is more cost-effective as it is diagnosed at young age and followed-up for a long time.
近年来，主动监测 (AS) 已被引入作为治疗甲状腺微小乳头状癌 (PTMC) 的早期手术 (ES) 的替代方法，因为其惰性特征和低死亡率。然而，根据每个国家的医疗体系，其成本效益尚未确定，而且目前的研究结果也存在差异。
基于一名 40 岁诊断为 PTMC 的患者的参考病例，构建了一个马尔可夫模型来比较 AS 和 ES 的成本效益。成本和转移概率源自韩国人群的先前临床研究，计算了增量成本效益比 (ICER) 和净货币收益 (NMB)。意愿支付 (WTP) 阈值设定为每获得一个质量调整生命年 (QALY) 支付 10 万美元。进行了敏感性分析以解决模型变量中的不确定性。
从基本情况来看，ES 的累积成本和效果均高于 AS。与 AS 相比，ES 的 ICER 为 6619.86 美元/QALY，低于设定的 WTP。AS 和 ES 之间的 NMB 差异随着阶段的增加而增加（第一阶段为 5980 美元，最后阶段为 159667 美元）。ICER 随着年龄的降低和手术成本的增加而增加。ES 效用评分越高，AS 越低，ES 的成本效益越高，WTP 设定为 3 万美元。
在当前韩国医疗体系中，ES 比 AS 更具成本效益。ES 更具成本效益，因为它在年轻时被诊断出来，并进行了长时间的随访。
