J Surg Res. 2022 Mar 17;275:273-280. doi: 10.1016/j.jss.2022.01.019. Online ahead of print.
ABSTRACT
INTRODUCTION: The American Thyroid Association (ATA) updated consensus guidelines in 2015 for radioactive iodine (RAI) and resection for low-risk papillary thyroid cancer. The objective of this study was to describe the evolution of institutional practice patterns and estimate the cost implications of these trends.
MATERIALS AND METHODS: Patients with cT1-T2N0 papillary thyroi d cancer were identified via an institutional tumor registry. Incidences of total thyroidectomy or RAI were tracked longitudinally using cumulative sum. Real-world costs for RAI and each surgical encounter were adjusted for inflation and standardized to national average costs from National Inpatient Sample cost data.
RESULTS: Sixty-one patients met inclusion criteria between 2007 and 2018. Among these, 28 patients underwent total thyroidectomies and received RAI treatments based on criteria pre-dating the 2015 ATA guidelines. Cumulative sum revealed significant decreases in the rate of total thyroidectomy following May 2015 (15.8% versus 59.5%, P = 0.002) and RAI following March 2013 (3.0% versus 32.1%, P = 0.002). There were no locoregional recurrences in either period. The average cost savings attributable to these institutional practice changes was $1580 per patient.
CONCLUSIONS: De-escalation in surgical and RAI utilization for low-risk papillary thyroid cancer accor ding to 2015 ATA guidelines is associated with a substantial decrease in real-world costs.
PMID:35306263 | DOI:10.1016/j.jss.2022.01.019
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