Cost-effectiveness of using recombinant human thyroid-stimulating hormone before radioiodine ablation for thyroid cancer treatment in Spanish hospitals

Rev Esp Med Nucl Imagen Mol. 2017 Nov-Dec;36(6):362-370. doi: 10.1016/j.remn.2017.04.005. Epub 2017 May 20.
[Article in English, Spanish]

Abstract

Objectives: In thyroid cancer treatment, the thyroid-stimulating hormone (TSH) must be elevated before radioiodine ablation, either by exogenous (with recombinant human thyrotropin [rhTSH]) or endogenous stimulation by thyroid hormone withdrawal (THW). The use of rhTSH avoids hypothyroidism and favours the subsequent elimination of radioiodine, but involves the cost of the product. For this reason, a cost-effectiveness analysis was performed, taking into account all costs involved and the benefits associated with the use of this therapy.

Material and methods: Using a Markov modelling with two analysis arms (rhTSH and THW), stratified into high (100mCi/3700 MBq) and low (30mCi/1110 MBq) radioiodine doses, and using 17 weekly cycles, the incremental cost per quality-adjusted life-year (QALY) related to the use of rhTSH was determined. The clinical inputs included in the model were based on published studies and in a treatment survey conducted in Spain.

Results: Radioablation preparation with rhTSH is superior to THW, showing additional benefits (0.048 AVAC), as well as cost savings (-€614.16), with an incremental cost-effectiveness rate (ICER) of -€12,795/QALY. The univariate and multivariate sensitivity analyses showed the result to be robust.

Conclusions: The use of rhTSH previous to radioablation in Spain has cost savings, as well as a series of health benefits for the patient, making it highly cost-effective.

Keywords: Ablación; Ablation; Cost-effectiveness; Coste-efectividad; Cáncer de tiroides; Hipotiroidismo; Hypothyroidism; Thyroid cancer; rhTSH.

MeSH terms

  • Ablation Techniques / economics*
  • Ablation Techniques / methods
  • Cost-Benefit Analysis*
  • Hospitals
  • Humans
  • Iodine Radioisotopes / economics*
  • Iodine Radioisotopes / therapeutic use*
  • Models, Economic
  • Recombinant Proteins / therapeutic use
  • Spain
  • Thyroid Neoplasms / economics*
  • Thyroid Neoplasms / therapy*
  • Thyrotropin / economics*
  • Thyrotropin / therapeutic use*

Substances

  • Iodine Radioisotopes
  • Recombinant Proteins
  • Thyrotropin