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Mehta V, Naraparaju A, Liao D, Davies L, Haugen BR, Kopp PA, Mandel SJ, Nikiforov YE, Ross DS, Shin JJ, Tuttle RM, Randolph GW. What's in a Name? A Cost-Effectiveness Analysis of the Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features' Nomenclature Revision. Thyroid 2022; 32:421-428. [PMID: 34915744 PMCID: PMC9469743 DOI: 10.1089/thy.2021.0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The noninvasive subtype of encapsulated follicular variant of papillary thyroid carcinoma (eFVPTC) has been reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 2016 to reflect the indolent behavior and favorable prognosis of this type of tumor. This terminology change has also de-escalated its management approach from cancer treatment to a more conservative treatment strategy befitting a benign thyroid neoplasm. Objective: To characterize the reduced health care costs and improved quality of life (QOL) from management of NIFTP as a nonmalignant tumor compared with the previous management as eFVPTC. Methods: A cost-effectiveness analysis was performed by creating Markov models to simulate two management strategies for NIFTP: (i) de-escalated management of the tumor as NIFTP involving lobectomy with reduced follow-up, (ii) management of the tumor as eFVPTC involving completion thyroidectomy/radioactive iodine ablation for some patients, and follow-up recommended for carcinoma. The model was simulated for 5 and 20 years following diagnosis of NIFTP. Aggregate costs and quality-life years were measured. One-way sensitivity analysis was performed for all variables. Results: Over a five-year simulation period, de-escalated management of NIFTP had a total cost of $12,380.99 per patient while the more aggressive management of the tumor as eFVPTC had a total cost of $16,264.03 per patient (saving $3883.05 over five years). Management of NIFTP provided 5.00 quality-adjusted life years, whereas management as eFVPTC provided 4.97 quality-adjusted life years. Sensitivity analyses showed that management of NIFTP always resulted in lower costs and greater quality-adjusted life years (QALYs) over the sensitivity ranges for individual variables. De-escalated management for NIFTP is expected to produce ∼$6-42 million in cost savings over a five-year period for these patients, and incremental 54-370 QALYs of increased utility in the United States. Conclusion: The degree of cost savings and improved patient utility of de-escalated NIFTP management compared with traditional management was estimated to be $3883.05 and 0.03 QALYs per patient. We demonstrate that these findings persisted in sensitivity analysis to account for variability in recurrence rate, surveillance approaches, and other model inputs. These findings allow for greater understanding of the economic and QOL impact of the NIFTP reclassification.
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Affiliation(s)
- Vikas Mehta
- Otorhinolaryngology–Head & Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
- Address correspondence to: Vikas Mehta, MD, MPH, Otorhinolaryngology–Head & Neck Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 3rd Floor MAP Bldg, Bronx, NY 10467, USA
| | | | - David Liao
- Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Louise Davies
- The VA Outcomes Group, White River Junction Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Bryan R. Haugen
- Division of Endocrinology Metabolism and Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Peter A. Kopp
- Division of Endocrinology Metabolism and Diabetes, University of Lausanne, Lausanne, Switzerland
- Division of Endocrinology Metabolism and Diabetes, Northwestern University, Chicago, Illinois, USA
| | - Susan J. Mandel
- Division of Endocrinology Metabolism and Diabetes, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas S. Ross
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer J. Shin
- Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Gregory W. Randolph
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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