Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China
ObjectivesIn this study, we compared the cost-effectiveness comparison of the active surveillance (AS) and early surgery (ES) approaches for papillary thyroid microcarcinoma (PTMC) from the perspective of the Chinese healthcare system.MethodsWe performed a cost-effectiveness analysis using a Markov...
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1166433/full |
| _version_ | 1828717276261515264 |
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| author | Min Lai Miao Miao Zhang Qing Qing Qin Yu An Yan Ting Li Wen Zhen Yuan |
| author_facet | Min Lai Miao Miao Zhang Qing Qing Qin Yu An Yan Ting Li Wen Zhen Yuan |
| author_sort | Min Lai |
| collection | DOAJ |
| description | ObjectivesIn this study, we compared the cost-effectiveness comparison of the active surveillance (AS) and early surgery (ES) approaches for papillary thyroid microcarcinoma (PTMC) from the perspective of the Chinese healthcare system.MethodsWe performed a cost-effectiveness analysis using a Markov model of PTMC we developed to evaluate the incremental cost-effectiveness ratio of AS and ES. Our reference case was of a 40-year-old woman diagnosed with unifocal (<10 mm) PTMC. Relevant data were extracted after an extensive literature review, and the cost incurred in each state was determined using China Medicare data on payments for ES and AS. The willingness-to-pay threshold was set at ¥242,928/quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to account for any uncertainty in the model’s variables. Additional subgroup analyses were performed to determine whether AS was cost-effective when different initial monitoring ages were used.ResultsES exhibited an effectiveness of 5.2 QALYs, whereas AS showed an effectiveness of 25.8 QALYs. Furthermore, the incremental cost-effectiveness ratio for ES versus AS was ¥1,009/QALY. The findings of all sensitivity analyses were robust. Compared with ES, AS was found to be the cost-effective strategy at initial monitoring ages of 20 and 60 years, with an incremental cost-effectiveness ratio of ¥3,431/QALY and −¥1,316/QALY at 20 and 60 years, respectively. AS was a more cost-effective strategy in patients with PTMC aged more than 60.ConclusionsWith respect to the norms of the Chinese healthcare system, AS was more cost-effective for PTMC over lifetime surveillance than ES. Furthermore, it was cost-effective even when the initial monitoring ages were different. In addition, if AS is incorporated into the management plan for PTMC in China at the earliest possible stage, a predicted savings of ¥10 × 108/year could be enabled for every 50,000 cases of PTMC, which indicates a good economic return for future management programs. The identification of such nuances can help physicians and patients determine the best and most individualized long-term management strategy for low-risk PTMC. |
| first_indexed | 2024-03-12T14:25:44Z |
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| id | doaj.art-dc256185f45b4eab964724407dff12ff |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-12T14:25:44Z |
| publishDate | 2023-08-01 |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-dc256185f45b4eab964724407dff12ff2023-08-18T08:43:26ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-08-011410.3389/fendo.2023.11664331166433Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in ChinaMin Lai0Miao Miao Zhang1Qing Qing Qin2Yu An3Yan Ting Li4Wen Zhen Yuan5The First School of Clinical Medicine, Lanzhou University, Lanzhou, ChinaThe First School of Clinical Medicine, Lanzhou University, Lanzhou, ChinaThe First School of Clinical Medicine, Lanzhou University, Lanzhou, ChinaThe First School of Clinical Medicine, Lanzhou University, Lanzhou, ChinaThe First School of Clinical Medicine, Lanzhou University, Lanzhou, ChinaDepartment of Oncological Surgery, First Hospital of Lanzhou University, Lanzhou, ChinaObjectivesIn this study, we compared the cost-effectiveness comparison of the active surveillance (AS) and early surgery (ES) approaches for papillary thyroid microcarcinoma (PTMC) from the perspective of the Chinese healthcare system.MethodsWe performed a cost-effectiveness analysis using a Markov model of PTMC we developed to evaluate the incremental cost-effectiveness ratio of AS and ES. Our reference case was of a 40-year-old woman diagnosed with unifocal (<10 mm) PTMC. Relevant data were extracted after an extensive literature review, and the cost incurred in each state was determined using China Medicare data on payments for ES and AS. The willingness-to-pay threshold was set at ¥242,928/quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to account for any uncertainty in the model’s variables. Additional subgroup analyses were performed to determine whether AS was cost-effective when different initial monitoring ages were used.ResultsES exhibited an effectiveness of 5.2 QALYs, whereas AS showed an effectiveness of 25.8 QALYs. Furthermore, the incremental cost-effectiveness ratio for ES versus AS was ¥1,009/QALY. The findings of all sensitivity analyses were robust. Compared with ES, AS was found to be the cost-effective strategy at initial monitoring ages of 20 and 60 years, with an incremental cost-effectiveness ratio of ¥3,431/QALY and −¥1,316/QALY at 20 and 60 years, respectively. AS was a more cost-effective strategy in patients with PTMC aged more than 60.ConclusionsWith respect to the norms of the Chinese healthcare system, AS was more cost-effective for PTMC over lifetime surveillance than ES. Furthermore, it was cost-effective even when the initial monitoring ages were different. In addition, if AS is incorporated into the management plan for PTMC in China at the earliest possible stage, a predicted savings of ¥10 × 108/year could be enabled for every 50,000 cases of PTMC, which indicates a good economic return for future management programs. The identification of such nuances can help physicians and patients determine the best and most individualized long-term management strategy for low-risk PTMC.https://www.frontiersin.org/articles/10.3389/fendo.2023.1166433/fullactive surveillance (AS)early surgerycost-effectiveness (CE)papillary thyroid microcarcinoma (PTMC)papillary thyroid cancer (PTC) |
| spellingShingle | Min Lai Miao Miao Zhang Qing Qing Qin Yu An Yan Ting Li Wen Zhen Yuan Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China Frontiers in Endocrinology active surveillance (AS) early surgery cost-effectiveness (CE) papillary thyroid microcarcinoma (PTMC) papillary thyroid cancer (PTC) |
| title | Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China |
| title_full | Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China |
| title_fullStr | Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China |
| title_full_unstemmed | Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China |
| title_short | Cost-effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in China |
| title_sort | cost effectiveness of active surveillance versus early surgery for thyroid micropapillary carcinoma based on diagnostic and treatment norms in china |
| topic | active surveillance (AS) early surgery cost-effectiveness (CE) papillary thyroid microcarcinoma (PTMC) papillary thyroid cancer (PTC) |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1166433/full |
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