Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study

Abstract

This study is to compare the health-related quality of life (HRQoL) and cost-effectiveness of radiofrequency ablation (RFA) and open thyroidectomy (OT) for benign thyroid nodules (BTNs) treatment. HRQoL and utility were assessed for 404 BTN patients immediately before treatments (RFA:OT = 137:267) and at 6-month visit. A cost-effectiveness analysis was performed from societal perspective in the China context. Resource use (hospitalization, sick leaves) was collected. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for RFA and OT. Sensitivity analyses of costs of RFA were performed. At 6-month visit, patients treated with RFA had significantly better HRQoL than patients treated with OT on general health (68.5 versus 66.7, P = 0.029), vitality (71.3 versus 67.5, P < 0.001) and mental health (80.9 versus 79.3, P = 0.038). RFA was more effective than OT in terms of quality-adjusted life-years (QALYs; 0.01QALY/patient) but more expensive (US$823/patient). The probability that RFA would be cost effective at a US$50,000/QALY threshold was 15.5% in China, and it would be increased to 88.4% when price of the RFA device was lowered by 30%. RFA exhibited a significant improvement of HRQoL relative to OT, but is unlikely to be cost effective at its current price in short time.

Figure 1. Flow chart for the management of thyroid nodules in our hospital.

RFA group, patients treated with radiofrequency ablation; OT group, patients treated with open thyroidectomy.

Figure 2. Absolute standardized differences.

Absolute standardized differences comparing the baseline characteristics of patients with benign thyroid nodules treated with radiofrequency ablation or open thyroidectomy before and after propensity score matching.

Figure 3. Graph shows the SF-36 dimension scores of the propensity score matched patients treated with radiofrequency ablation (RFA) or open thyroidectomy (OT) at 6 months follow up, together with those for the general population sample.

*P < 0.05,***P < 0.001.

Figure 4. Acceptability curves of radiofrequency ablation (RFA) compared with open thyroidectomy (OT).

Cost effectiveness acceptability curve using the net–monetary benefit approach (10,000 bootstrap replications) represents the probability (y-axis) that RFA is more cost effective compared with OT at the range of willingness-to-pay thresholds (US$ per quality-adjusted life-year [QALY]) on the x-axis. The curve is generated by repeating the procedure for various thresholds, with the threshold on x-axis and the probability of RFA to be cost effective on y-axis. Acceptability curves are presented here taking into account direct costs only or total (direct and indirect) costs.