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Cost Effectiveness of Routine Laryngoscopy in the Surgical Treatment of Differentiated Thyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

Some surgeons perform flexible fiberoptic laryngoscopy (FFL) in all patients prior to thyroid cancer operations. Given the low likelihood of recurrent laryngeal nerve (RLN) or aerodigestive invasion in clinically low-risk thyroid cancers, the value of routine FFL in this group is controversial. We hypothesized that routine preoperative FFL would not be cost effective in low-risk differentiated thyroid cancer (DTC).

Methods

A decision model was constructed comparing preoperative FFL versus surgery without FFL in a clinical stage T2 N0 DTC patient without voice symptoms. Total thyroidectomy and definitive hemithyroidectomy were both modeled as possible initial surgical approaches. Outcome probabilities and their corresponding utilities were estimated via literature review, and costs were estimated using Medicare reimbursement data. Sensitivity analysis was conducted to examine the uncertainty of cost, probability, and utility estimates in the model.

Results

When the initial surgical strategy was total thyroidectomy, routine preoperative FFL produced an incremental cost of $183 and an incremental effectiveness of 0.000126 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) for routine FFL prior to total thyroidectomy was $1.45 million/QALY, exceeding the $100,000/QALY threshold for cost effectiveness. Routine FFL became cost effective if the preoperative probability of asymptomatic vocal cord paralysis increased from 1.0% to 4.9%, or if the cost of preoperative FFL decreased from $128 to $27. Changing the extent of initial surgery to hemithyroidectomy produced a higher ICER for routine FFL of $1.7 million/QALY.

Conclusion

Routine preoperative FFL is not cost effective in asymptomatic patients with sonographically low-risk DTC, regardless of the initial planned extent of surgery.

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ACKNOWLEDGMENTS

Preliminary results from this study were presented during the panel discussion “Raising Our Voices” at the 2014 Annual Meeting of the American Association of Endocrine Surgeons, Boston, MA, USA, 27–29 April 2014.

DISCLOSURES

Julie Ann Sosa is a member of the Data Monitoring Committee of the Medullary Thyroid Cancer Consortium Registry supported by GlaxoSmithKline, Novo Nordisk, Astra Zeneca, and Eli Lilly.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Kyle Zanocco MD, MS, James X. Wu MD & Michael W. Yeh MD, FACS

  2. Department of Surgery, Section of Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    David J. Kaltman MD & Cord Sturgeon MD, MS, FACS

  3. Department of Surgery, Section of General Surgery – Surgical Oncology, University of Nebraska Medical Center, Omaha, NE, USA

    Abbey Fingeret MD

  4. Department of Surgery, Section of Endocrine Surgery, NYU Langone Medical Center, New York, NY, USA

    Keith S. Heller MD, FACS

  5. Department of Surgery, Section of Endocrine Surgery, Columbia University Medical Center, New York, NY, USA

    James A. Lee MD, FACS

  6. Department of Surgery, Section of Endocrine Surgery, Duke University Medical Center, Durham, NC, USA

    Julie Ann Sosa MD, FACS

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  1. Kyle Zanocco MD, MS
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  2. David J. Kaltman MD
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  8. Julie Ann Sosa MD, FACS
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  9. Cord Sturgeon MD, MS, FACS
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Correspondence to Kyle Zanocco MD, MS.

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Zanocco, K., Kaltman, D.J., Wu, J.X. et al. Cost Effectiveness of Routine Laryngoscopy in the Surgical Treatment of Differentiated Thyroid Cancer. Ann Surg Oncol 25, 949–956 (2018). https://doi.org/10.1245/s10434-018-6356-2

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  • DOI: https://doi.org/10.1245/s10434-018-6356-2

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