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Eur J Endocrinol. 2016 Dec;175(6):595-603. Epub 2016 Sep 15.

Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.

Author information

1
Department of Clinical PharmacologyRoyal Brisbane and Women's Hospital, Herston, Queensland, Australia peter.donovan@health.qld.gov.au.
2
School of Medicine and BiosciencesUniversity of Queensland, Herston, Queensland, Australia.
3
Department of Endocrinology and DiabetesRoyal Brisbane and Women's Hospital, Herston, Queensland, Australia.
4
Population Health DepartmentQIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
5
Consultant Health EconomistCambridge, UK.
6
Centre for Applied Health EconomicsLogan Campus, Griffith University, Meadowbrook, Queensland, Australia.

Abstract

OBJECTIVE:

Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia.

METHODS:

We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD).

RESULTS:

RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD.

CONCLUSIONS:

In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies.

PMID:
27634939
DOI:
10.1530/EJE-16-0527
[Indexed for MEDLINE]

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