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Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study

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ABSTRACT

This study is to compare the health-related quality of life (HRQoL) and cost-effectiveness of radiofrequency ablation (RFA) and open thyroidectomy (OT) for benign thyroid nodules (BTNs) treatment. HRQoL and utility were assessed for 404 BTN patients immediately before treatments (RFA:OT = 137:267) and at 6-month visit. A cost-effectiveness analysis was performed from societal perspective in the China context. Resource use (hospitalization, sick leaves) was collected. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for RFA and OT. Sensitivity analyses of costs of RFA were performed. At 6-month visit, patients treated with RFA had significantly better HRQoL than patients treated with OT on general health (68.5 versus 66.7, P = 0.029), vitality (71.3 versus 67.5, P < 0.001) and mental health (80.9 versus 79.3, P = 0.038). RFA was more effective than OT in terms of quality-adjusted life-years (QALYs; 0.01QALY/patient) but more expensive (US$823/patient). The probability that RFA would be cost effective at a US$50,000/QALY threshold was 15.5% in China, and it would be increased to 88.4% when price of the RFA device was lowered by 30%. RFA exhibited a significant improvement of HRQoL relative to OT, but is unlikely to be cost effective at its current price in short time.

No MeSH data available.


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Flow chart for the management of thyroid nodules in our hospital.RFA group, patients treated with radiofrequency ablation; OT group, patients treated with open thyroidectomy.
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f1: Flow chart for the management of thyroid nodules in our hospital.RFA group, patients treated with radiofrequency ablation; OT group, patients treated with open thyroidectomy.

Mentions: From June 2012 to January 2016, 3502 patients underwent invasive therapy for TN(s) as a first-line treatment in our center. Among them, 404 patients were included in this study and were classified into RFA group (n = 137) or OT group (n = 267) according to the initial treatment strategy (Fig. 1). In our institution, RFA or OT was considered if a patient with TN(s) reported of compressive symptoms or cosmetic problems or anxiety about a malignancy. For RFA there was an additional requirement that cytologic confirmation of benign nature of the nodule with ultrasound (US)-guided fine needle aspiration cytology (FNAC) examination according to the American Bethesda System for Reporting Thyroid Cytopathology10 and nodule without changes on US at least 12-month. Also, for the patient ineligibility to undergo surgery for high thyroid surgical risk (poor surgical candidates, falling general anaesthesia due to a medical condition, repeated neck dissection), RFA would be required. Further, for a patient that was suitable for both RFA and OT, the definitive treatment modality was “self-selecting” after a full explanation of the differences between two procedures. The RFA patients were diagnosed cytologically and the OT patients were diagnosed by surgical pathology. For patients in the RFA group, 48.9% (67/137) had clinical symptoms or cosmetic problems and the rest of them were anxious about a malignant change; while for patients in the OT group, 36.7% (98/267) were been diagnosed with thyroid nodules that assessed as suspicious for malignancy according to the US Thyroid Imaging Reporting and Data Systems (TI-RADS) (rated ≥ 4)11 following the regular medical checkup, 32.6% (87/267) had clinical symptoms, 22.1% (59/267) with nodules increased obviously in a short time (double in size within 6 months) and 8.6% (23/267) were anxious about a malignant change. All the enrolled patients fulfilled the following criteria: patients with valid questionnaires (with complete data); underwent a single treatment method of RFA or hemithyroidectomy; serum levels of thyrotropin, thyroid hormone and calcitonin within normal limits. Exclusion criteria included patients who had already treated with contralateral thyroid lobectomy. Further, patients with major comorbidities that suspected to have a substantial HRQoL impact (e.g. malignant tumors, chronic obstructive pulmonary disease(COPD), congestive heart failure)12 were also excluded.


Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study
Flow chart for the management of thyroid nodules in our hospital.RFA group, patients treated with radiofrequency ablation; OT group, patients treated with open thyroidectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121639&req=5

f1: Flow chart for the management of thyroid nodules in our hospital.RFA group, patients treated with radiofrequency ablation; OT group, patients treated with open thyroidectomy.
Mentions: From June 2012 to January 2016, 3502 patients underwent invasive therapy for TN(s) as a first-line treatment in our center. Among them, 404 patients were included in this study and were classified into RFA group (n = 137) or OT group (n = 267) according to the initial treatment strategy (Fig. 1). In our institution, RFA or OT was considered if a patient with TN(s) reported of compressive symptoms or cosmetic problems or anxiety about a malignancy. For RFA there was an additional requirement that cytologic confirmation of benign nature of the nodule with ultrasound (US)-guided fine needle aspiration cytology (FNAC) examination according to the American Bethesda System for Reporting Thyroid Cytopathology10 and nodule without changes on US at least 12-month. Also, for the patient ineligibility to undergo surgery for high thyroid surgical risk (poor surgical candidates, falling general anaesthesia due to a medical condition, repeated neck dissection), RFA would be required. Further, for a patient that was suitable for both RFA and OT, the definitive treatment modality was “self-selecting” after a full explanation of the differences between two procedures. The RFA patients were diagnosed cytologically and the OT patients were diagnosed by surgical pathology. For patients in the RFA group, 48.9% (67/137) had clinical symptoms or cosmetic problems and the rest of them were anxious about a malignant change; while for patients in the OT group, 36.7% (98/267) were been diagnosed with thyroid nodules that assessed as suspicious for malignancy according to the US Thyroid Imaging Reporting and Data Systems (TI-RADS) (rated ≥ 4)11 following the regular medical checkup, 32.6% (87/267) had clinical symptoms, 22.1% (59/267) with nodules increased obviously in a short time (double in size within 6 months) and 8.6% (23/267) were anxious about a malignant change. All the enrolled patients fulfilled the following criteria: patients with valid questionnaires (with complete data); underwent a single treatment method of RFA or hemithyroidectomy; serum levels of thyrotropin, thyroid hormone and calcitonin within normal limits. Exclusion criteria included patients who had already treated with contralateral thyroid lobectomy. Further, patients with major comorbidities that suspected to have a substantial HRQoL impact (e.g. malignant tumors, chronic obstructive pulmonary disease(COPD), congestive heart failure)12 were also excluded.

View Article: PubMed Central - PubMed

ABSTRACT

This study is to compare the health-related quality of life (HRQoL) and cost-effectiveness of radiofrequency ablation (RFA) and open thyroidectomy (OT) for benign thyroid nodules (BTNs) treatment. HRQoL and utility were assessed for 404 BTN patients immediately before treatments (RFA:OT = 137:267) and at 6-month visit. A cost-effectiveness analysis was performed from societal perspective in the China context. Resource use (hospitalization, sick leaves) was collected. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for RFA and OT. Sensitivity analyses of costs of RFA were performed. At 6-month visit, patients treated with RFA had significantly better HRQoL than patients treated with OT on general health (68.5 versus 66.7, P = 0.029), vitality (71.3 versus 67.5, P < 0.001) and mental health (80.9 versus 79.3, P = 0.038). RFA was more effective than OT in terms of quality-adjusted life-years (QALYs; 0.01QALY/patient) but more expensive (US$823/patient). The probability that RFA would be cost effective at a US$50,000/QALY threshold was 15.5% in China, and it would be increased to 88.4% when price of the RFA device was lowered by 30%. RFA exhibited a significant improvement of HRQoL relative to OT, but is unlikely to be cost effective at its current price in short time.

No MeSH data available.


Related in: MedlinePlus