Researchers at Tulane University School of Medicine and Johns Hopkins School of Medicine determined that for patients who have had a biopsy suspicious for papillary thyroid cancer, a total thyroidectomy to remove the thyroid gland may consume more healthcare dollars and result in a lower quality of life as compared to a less extensive lobectomy that removes only the thyroid lobe. The lead researcher, Zaid Al-Quarayshi, states, “It is important to note, this finding does not mean that lobectomy is only a cost-effective alternative; we call a strategy ‘cost-effective’ compared with the alternative if it costs more, or the same, but is associated with better effectiveness.” In this study, lobectomy costs less but was also associated with better outcomes, he reported.
American Thyroid Association (ATA) Clinical Guidelines now support lobectomy alone for differentiated thyroid cancers, like papillary thyroid carcinoma, of 4 cm or less in carefully selected situations. Papillary thyroid cancers are usually small, grow slowly, carry a lower risk of spreading beyond the thyroid gland, and have higher survival rates than medullary thyroid cancer. Despite ATA guidelines recommending lobectomy for Stage I and II papillary thyroid cancer, complete thyroidectomy remains the most common procedure for all types of thyroid cancers.
The researchers used a model called Quality-Adjusted Life Year (QALY) to calculate the cost and clinical effectiveness of lobectomy versus total thyroidectomy when the biopsy is suspicious for papillary thyroid cancer. “QALY is a standardized value from 0 to 1 that represents the burden of certain disease. It is based on two elements: quality of life and time. A value of 0 represents death, and a value of 1 represents a year of perfect health without any diseases,” describes Dr. Al-Quarayshi. The study found lobectomy had a QALY 0.25 greater than total thyroidectomy in a model based on 20 years of patient follow-up. Dr. Al-Quarayshi concludes, “If the American Thyroid Association Clinical Guidelines become widely adopted, further study is warranted to re-evaluate the clinical outcomes on long-term follow-up in patients who underwent lobectomy instead of total thyroidectomy.”
The Thyroid Cancer Care Collaborative (TCCC) aims to improve patient care by updating both physicians and patients on treatment options in order to ensure patients are receiving the most effective care. The TCCC also stays up to date with the ATA, programming the application to automatically provide users with the clinical course suggested by national guidelines.