BACKGROUND
Thyroid cancer is a commonly diagnosed cancer and, until recently, the fastest rising cancer in women. Many of these newly diagnosed cancers are low risk papillary thyroid cancer. These low risk cancers will rarely, if ever, cause death and many may never expand outside the thyroid. Low risk papillary thyroid cancer may be treated with a surgical procedure called thyroid lobectomy, which has been the most common recommendation. However, many studies from Asia and now within the United States have shown that following these low risk cancers by ultrasound and deferring surgery, which is called active surveillance, is an acceptable treatment option. If the cancer grows on follow up imaging, then lobectomy is recommended.

This study looked at the cost effectiveness (cost vs. benefit) of both approaches in the management of the low risk papillary thyroid cancer. The goal of the study was to look at which approach may be more cost effective over the long term.

THE FULL ARTICLE TITLE
Youssef MR et al 2022 Thyroid lobectomy as a costeffective approach in low-risk papillary thyroid cancer versus active surveillance. Surgery 171:190–196. PMID: 34384606.

SUMMARY OF THE STUDY
The study used the example of a healthy, 40-year-old female patient with a biopsy-proven, single, low-risk papillary thyroid cancer (<15 mm) without features or risk factors that would require a more surgery. It examined both treatment approaches to determine the cost effectiveness of both approaches using statistical modeling.

They found that, although thyroid lobectomy consistently cost more than active surveillance, it was associated with greater quality of life starting from a patient age of 40 years. In the case of 20 years of follow-up for both thyroid lobectomy and active surveillance for middle-aged patients (those diagnosed between 40 and 59 years of age), lobectomy was more expensive but also afforded patients increased quality-adjusted life-years. However, starting at 69 years of age, active surveillance was consistently less costly than thyroid lobectomy and afforded patients increased qualityadjusted life-years.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The study showed that the cost effectiveness of treatment options for low risk thyroid cancer was determined by patient age. Thyroid lobectomy is more cost effective in patients less than 69 years of age. In patients above the age of 69 years, active surveillance was found to be more cost effective. However, individual patient preferences and physician experience with these approaches should also be considered when making these decisions.

— Vibhavasu Sharma, MD, FACE

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