Total Thyroidectomy Versus Lobectomy in Small Nodules Suspicious for Papillary Thyroid Cancer: Cost-Effectiveness Analysis

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.

Study design: Cost-effectiveness analysis.

Methods: 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).

Results: 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%.

Conclusions: Total thyroidectomy is not just cost prohibitive but also associated with a lower effectiveness compared to lobectomy.

Level of evidence: 2c Laryngoscope, 2020.

Keywords: Outcomes/cost effectiveness; papillary thyroid cancer; thyroidectomy.

MeSH terms

  • Adult
  • Biopsy, Fine-Needle
  • Cost-Benefit Analysis*
  • Decision Trees
  • Female
  • Humans
  • Male
  • Markov Chains
  • Quality-Adjusted Life Years
  • Thyroid Cancer, Papillary / pathology
  • Thyroid Cancer, Papillary / surgery*
  • Thyroid Nodule / pathology
  • Thyroid Nodule / surgery*
  • Thyroidectomy / economics
  • Thyroidectomy / methods*