FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial

Elizabeth J de Koster, Dennis Vriens, Maarten O van Aken, Lioe-Ting Dijkhorst-Oei, Wim J G Oyen, Robin P Peeters, Abbey Schepers, Lioe-Fee de Geus-Oei, Wilbert B van den Hout, EfFECTS trial study group, Elizabeth J de Koster, Dennis Vriens, Maarten O van Aken, Lioe-Ting Dijkhorst-Oei, Wim J G Oyen, Robin P Peeters, Abbey Schepers, Lioe-Fee de Geus-Oei, Wilbert B van den Hout, EfFECTS trial study group

Abstract

Purpose: To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules.

Methods: Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account.

Results: The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was - €1000 (95% CI: - €2100 to €0) for thyroid nodule-related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was - €4500 (- €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was - €9900 (- €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (- 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (- 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty.

Conclusion: Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule-related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules.

Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://ichgcp.net/clinical-trials-registry/NCT02208544 .

Keywords: Cost-effectiveness; Costs; Health-related quality of life; Indeterminate thyroid nodule; QALY; Thyroid carcinoma; Thyroid surgery; [18F]FDG-PET/CT.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the first year, visualizing the study procedures, observed treatment and treatment outcomes, and health state at the end of the first year of all patients who participated in the EfFECTS trial. cTT, completing total thyroidectomy. Fu, follow-up. HT, hemithyroidectomy (including isthmus resection (n = 3) and hemithyroidectomy plus nodulectomy (n = 2). POHT, postoperative levothyroxine-dependent hypothyroidism after partial thyroidectomy procedure. PSC, permanent surgical complication, including recurrent nerve paralysis and permanent hypoparathyroidism. RAI, radioiodine ablative therapy. TSC, transient surgical complication, including haematoma with re-exploration surgery, wound infection, seroma, and transient hypoparathyroidism. TT, total thyroidectomy. a: One patient underwent RAI after initial, uncomplicated TT for malignancy; two patients underwent cTT for malignancy but no RAI
Fig. 2
Fig. 2
Markov tree visualizing the health states (ovals), possible transitions between health states after each 1-year cycle length (arrows), treatments (boxes), and decisions (diamonds) that patients may encounter in the Markov model. Patients enter the model in their actual health state at the end of the first year. Grey-shaded fields and corresponding transitions only apply to patients with malignancy; all white fields and corresponding transitions apply to patients with either benign or malignant lesions, although different (transition) probabilities, costs, and utilities may apply as presented in Tables 2 and 3. cTT, completing total thyroidectomy. HT, hemithyroidectomy. RAI, radioiodine ablative therapy. TT, total thyroidectomy
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve (CEAC). For increasing willingness-to-pay thresholds, this figure shows the probability that [18F]FDG-PET/CT-driven management is cost-effective as compared to diagnostic surgery. Analysis was performed for the first-year (dashed line) and lifelong (continuous line) cost-effectiveness analysis
Fig. 4
Fig. 4
Tornado plot showing the results of the univariate sensitivity analysis on the lifelong incremental net monetary benefit per patient (x-axis) of [18F]FDG-PET/CT-driven management as compared to diagnostic surgery, for a willingness to pay of €50,000 per QALY. Dark grey bars represent lower parameter values and light grey bars represent higher parameter values. The vertical line at €0 represents the break-even situation, i.e., when both strategies have equal net benefit. The vertical line at €30,000 represents the incremental net benefit of the base case analysis for a willingness to pay of €50,000 per QALY. HT, hemithyroidectomy. QALY, quality-adjusted life year

References

    1. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27:1341–1346. doi: 10.1089/thy.2017.0500.
    1. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56:333–339. doi: 10.1159/000339959.
    1. Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The diagnosis and management of thyroid nodules: a review. JAMA. 2018;319:914–924. doi: 10.1001/jama.2018.0898.
    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133. doi: 10.1089/thy.2015.0020.
    1. Aydemirli MD, Snel M, van Wezel T, Ruano D, Obbink CMH, van den Hout WB, et al. Yield and costs of molecular diagnostics on thyroid cytology slides in the Netherlands, adapting the Bethesda classification. Endocrinology, Diabetes & Metabolism. 2021. 10.1002/edm2.293.
    1. Husson O, Haak HR, Oranje WA, Mols F, Reemst PH, van de Poll-Franse LV. Health-related quality of life among thyroid cancer survivors: a systematic review. Clin Endocrinol. 2011;75:544–554. doi: 10.1111/j.1365-2265.2011.04114.x.
    1. Vriens D, de Wilt JH, van der Wilt GJ, Netea-Maier RT, Oyen WJ, de Geus-Oei LF. The role of [18F]-2-fluoro-2-deoxy-d-glucose-positron emission tomography in thyroid nodules with indeterminate fine-needle aspiration biopsy: systematic review and meta-analysis of the literature. Cancer. 2011;117:4582–4594. doi: 10.1002/cncr.26085.
    1. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28:271–276. doi: 10.1007/s00268-003-6903-1.
    1. Steward DL, Carty SE, Sippel RS, Yang SP, Sosa JA, Sipos JA, et al. Performance of a multigene genomic classifier in thyroid nodules with indeterminate cytology: a prospective blinded multicenter study. JAMA Oncol. 2018;5:204–212. doi: 10.1001/jamaoncol.2018.4616.
    1. Angell TE, Heller HT, Cibas ES, Barletta JA, Kim MI, Krane JF, et al. Independent comparison of the afirma genomic sequencing classifier and gene expression classifier for cytologically indeterminate thyroid nodules. Thyroid. 2019;29:650–656. doi: 10.1089/thy.2018.0726.
    1. de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van GI, Hamming J, Corssmit EPM, et al. Diagnostic utility of molecular and imaging biomarkers in cytological indeterminate thyroid nodules. Endocr Rev. 2018;39:154–191. doi: 10.1210/er.2017-00133.
    1. Evidence Based Nation-wide Guideline Thyroid Carcinoma version 2.0. 2014. . Accessed 7 July 2021.
    1. de Koster EJ, de Geus-Oei LF, Brouwers AH, van Dam EWCM, Dijkhorst-Oei LT, van Engen-van Grunsven ACH, et al. [18F]FDG-PET/CT to prevent futile surgery in indeterminate thyroid nodules: a blinded, randomised controlled multicentre trial. Eur J Nucl Med Mol Imaging. 2022 doi: 10.1007/s00259-021-05627-2.
    1. Vriens D, Adang EM, Netea-Maier RT, Smit JW, de Wilt JH, Oyen WJ, et al. Cost-effectiveness of FDG-PET/CT for cytologically indeterminate thyroid nodules: a decision analytic approach. J Clin Endocrinol Metab. 2014;99:3263–3274. doi: 10.1210/jc.2013-3483.
    1. Haugen BR, Sawka AM, Alexander EK, Bible KC, Caturegli P, Doherty GM, et al. American Thyroid Association Guidelines on the management of thyroid nodules and differentiated thyroid cancer task force review and recommendation on the proposed renaming of encapsulated follicular variant papillary thyroid carcinoma without invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Thyroid. 2017;27:481–483. doi: 10.1089/thy.2016.0628.
    1. Lloyd RV, Osamura RY, Klöppel G, Rosai J. WHO Classification of Tumours of Endocrine Organs. WHO Classification of Tumours, 4th ed. Lyon, France: IARC; 2017.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20:1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Bouwmans C, Krol M, Severens H, Koopmanschap M, Brouwer W, Hakkaart-van RL. The iMTA Productivity Cost Questionnaire: a standardized instrument for measuring and valuing health-related productivity losses. Value in health. 2015;18:753–758. doi: 10.1016/j.jval.2015.05.009.
    1. iMTA Productivity and Health Research Group. Manual iMTA Medical Cost Questionnaire (iMCQ). . Accessed 7 Jul 2021.
    1. Versteegh MM, Vermeulen KM, Evers SMAA, de Wit GA, Prenger R, Stolk EA. Dutch Tariff for the five-level version of EQ-5D. Value in health. 2016;19:343–352. doi: 10.1016/j.jval.2016.01.003.
    1. EQ-5D-5L User Guide. 2019. . Accessed 7 July 2021.
    1. Dutch Healthcare Authority (NZa). Open data of the Dutch Healthcare Authority (NZa). 2020. . Accessed 24 Aug 2021.
    1. Hakkaart-van Roijen L, Van der Linden N, Bouwmans CAM, Kanters TA, Tan SS. Costing manual: methodology of costing research and reference prices for economic evaluations in healthcare. Rotterdam, the Netherlands; 2015.
    1. Dutch Consumer Price index. . Accessed 14 Apr 2021.
    1. Statistics Netherlands. CBS Life tables and survival analyses. 2021. . Accessed 1 Jul 2021.
    1. Balentine CJ, Vanness DJ, Schneider DF. Cost-effectiveness of lobectomy versus genetic testing (Afirma®) for indeterminate thyroid nodules: considering the costs of surveillance. Surgery. 2018;163:88–96. doi: 10.1016/j.surg.2017.10.004.
    1. Labourier E. Utility and cost-effectiveness of molecular testing in thyroid nodules with indeterminate cytology. Clin Endocrinol. 2016;85:624–631. doi: 10.1111/cen.13096.
    1. Li H, Robinson KA, Anton B, Saldanha IJ, Ladenson PW. Cost-effectiveness of a novel molecular test for cytologically indeterminate thyroid nodules. J Clin Endocrinol Metab. 2011;96:E1719–E1726. doi: 10.1210/jc.2011-0459.
    1. Nicholson KJ, Roberts MS, McCoy KL, Carty SE, Yip L. Molecular testing versus diagnostic lobectomy in Bethesda III/IV thyroid nodules: a cost-effectiveness analysis. Thyroid. 2019;29:1237–1243. doi: 10.1089/thy.2018.0779.
    1. Zanocco KA, Wang MM, Yeh MW, Livhits MJ. Selective use of molecular testing based on sonographic features of cytologically indeterminate thyroid nodules: a decision analysis. World journal of surgery. 2019:393–401. 10.1007/s00268-019-05177-7.
    1. van Buuren S. Flexible Imputation of Missing Data. 2. Boca Raton, FL, USA: CRC Press; 2018.
    1. Olvera Astivia OL, Zumbo BD. Heteroskedasticity in multiple regression analysis: what it is, how to detect it and how to solve it with applications in R and SPSS. Practical Assessment, Research, and Evaluation. 2019;24. 10.7275/q5xr-fr95.
    1. Kahan BC, Morris TP. Reporting and analysis of trials using stratified randomisation in leading medical journals: review and reanalysis. BMJ. 2012;345:e5840. doi: 10.1136/bmj.e5840.
    1. Pomp M, Brouwer W, Rutten F. QALY-time: New medical technology, cost-effectiveness and guidelines (CPB Document 152). 2007.
    1. Hu QL, Schumm MA, Zanocco KA, Yeh MW, Livhits MJ, Wu JX. Cost analysis of reflexive versus selective molecular testing for indeterminate thyroid nodules. Surgery. 2021 doi: 10.1016/j.surg.2021.04.050.
    1. Singh Ospina N, Maraka S, Espinosa de Ycaza AE, Brito JP, Castro MR, Morris JC, et al. Prognosis of patients with benign thyroid nodules: a population-based study. Endocrine. 2016;54:148–55. 10.1007/s12020-016-0967-9.
    1. Nou E, Kwong N, Alexander LK, Cibas ES, Marqusee E, Alexander EK. Determination of the optimal time interval for repeat evaluation after a benign thyroid nodule aspiration. J Clin Endocrinol Metab. 2014;99:510–516. doi: 10.1210/jc.2013-3160.
    1. Durante C, Costante G, Lucisano G, Bruno R, Meringolo D, Paciaroni A, et al. The natural history of benign thyroid nodules. JAMA. 2015;313:926–935. doi: 10.1001/jama.2015.0956.
    1. Schumm MA, Nguyen DT, Kim J, Tseng CH, Chow AY, Shen N, et al. Longitudinal assessment of quality of life following molecular testing for indeterminate thyroid nodules. Ann Surg Oncol. 2021 doi: 10.1245/s10434-021-10375-6.
    1. Lee S, Skelton TS, Zheng F, Schwartz KA, Perrier ND, Lee JE, et al. The biopsy-proven benign thyroid nodule: is long-term follow-up necessary? Journal of the American College of Surgeons. 2013;217:81–8; discussion 8–9. 10.1016/j.jamcollsurg.2013.03.014.
    1. Ajmal S, Rapoport S, Ramirez Batlle H, Mazzaglia PJ. The natural history of the benign thyroid nodule: what is the appropriate follow-up strategy? J Am Coll Surg. 2015;220:987–992. doi: 10.1016/j.jamcollsurg.2014.12.010.
    1. Qichang W, Jinming S, Lu L, Bin J, Renjie W, Xiuying Z. Comparison of 18F-FDG-PET and 18F-FDG-PET/CT for the diagnostic performance in thyroid nodules with indeterminate cytology: a meta-analysis. Medicine. 2020;99:1–9. doi: 10.1097/MD.0000000000020446.
    1. Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordonez NG, et al. Prognostic factors in patients with Hurthle cell neoplasms of the thyroid. Cancer. 2003;97:1186–1194. doi: 10.1002/cncr.11176.
    1. Matsuzu K, Sugino K, Masudo K, Nagahama M, Kitagawa W, Shibuya H, et al. Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J Surg. 2014;38:68–79. doi: 10.1007/s00268-013-2224-1.
    1. Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Tuttle RM, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2012;151:571–579. doi: 10.1016/j.surg.2011.08.016.
    1. Sugino K, Kameyama K, Ito K, Nagahama M, Kitagawa W, Shibuya H, et al. Outcomes and prognostic factors of 251 patients with minimally invasive follicular thyroid carcinoma. Thyroid. 2012;22:798–804. doi: 10.1089/thy.2012.0051.
    1. Thompson LD, Wieneke JA, Paal E, Frommelt RA, Adair CF, Heffess CS. A clinicopathologic study of minimally invasive follicular carcinoma of the thyroid gland with a review of the English literature. Cancer. 2001;91:505–24. 10.1002/1097-0142(20010201)91:3<505::aid-cncr1029>;2-6.
    1. D'Avanzo A, Treseler P, Ituarte PH, Wong M, Streja L, Greenspan FS, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer. 2004;100:1123–1129. doi: 10.1002/cncr.20081.
    1. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, et al. Extent of surgery affects survival for papillary thyroid cancer. Annals of surgery. 2007;246:375–81; discussion 81–4. 10.1097/SLA.0b013e31814697d9.
    1. Bojoga A, Koot A, Bonenkamp J, de Wilt J, IntHout J, Stalmeier P, et al. The impact of the extent of surgery on the long-term outcomes of patients with low-risk differentiated non-medullary thyroid cancer: a systematic meta-analysis. J Clin Med. 2020;9. 10.3390/jcm9072316.
    1. Chan S, Karamali K, Kolodziejczyk A, Oikonomou G, Watkinson J, Paleri V, et al. Systematic review of recurrence rate after hemithyroidectomy for low-risk well-differentiated thyroid cancer. Eur Thyroid J. 2020;9:73–84. doi: 10.1159/000504961.
    1. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–428. doi: 10.1016/0002-9343(94)90321-2.
    1. Kushchayeva Y, Duh QY, Kebebew E, D'Avanzo A, Clark OH. Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with Hurthle cell or follicular thyroid cancer. Am J Surg. 2008;195:457–462. doi: 10.1016/j.amjsurg.2007.06.001.
    1. Oluic B, Paunovic I, Loncar Z, Djukic V, Diklic A, Jovanovic M, et al. Survival and prognostic factors for survival, cancer specific survival and disease free interval in 239 patients with Hurthle cell carcinoma: a single center experience. BMC Cancer. 2017;17:371. doi: 10.1186/s12885-017-3370-x.
    1. Castagna MG, Maino F, Cipri C, Belardini V, Theodoropoulou A, Cevenini G, et al. Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients. Eur J Endocrinol. 2011;165:441–446. doi: 10.1530/EJE-11-0466.
    1. Pitoia F, Jerkovich F, Urciuoli C, Schmidt A, Abelleira E, Bueno F, et al. Implementing the modified 2009 American thyroid association risk stratification system in thyroid cancer patients with low and intermediate risk of recurrence. Thyroid. 2015;25:1235–1242. doi: 10.1089/thy.2015.0121.
    1. Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20:1341–1349. doi: 10.1089/thy.2010.0178.
    1. Vaisman F, Momesso D, Bulzico DA, Pessoa CH, Dias F, Corbo R, et al. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy. Clin Endocrinol. 2012;77:132–138. doi: 10.1111/j.1365-2265.2012.04342.x.
    1. Goffredo P, Cheung K, Roman SA, Sosa JA. Can minimally invasive follicular thyroid cancer be approached as a benign lesion?: a population-level analysis of survival among 1,200 patients. Ann Surg Oncol. 2013;20:767–772. doi: 10.1245/s10434-012-2697-4.
    1. Zhou X, Zheng Z, Chen C, Zhao B, Cao H, Li T, et al. Clinical characteristics and prognostic factors of Hurthle cell carcinoma: a population based study. BMC Cancer. 2020;20:407. doi: 10.1186/s12885-020-06915-0.
    1. Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, Reed SD, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Annals of surgery. 2014;260:601–5; discussion 5–7. 10.1097/SLA.0000000000000925.
    1. Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer. 2000;89:202–17. 10.1002/1097-0142(20000701)89:1<202::aid-cncr27>;2-a.
    1. Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393:667–673. doi: 10.1007/s00423-008-0366-7.
    1. Elfenbein DM, Schneider DF, Chen H, Sippel RS. Surgical site infection after thyroidectomy: a rare but significant complication. J Surg Res. 2014;190:170–176. doi: 10.1016/j.jss.2014.03.033.
    1. Sheahan P, O'Connor A, Murphy MS. Comparison of incidence of postoperative seroma between flapless and conventional techniques for thyroidectomy: a case-control study. Clin Otolaryngol. 2012;37:130–135. doi: 10.1111/j.1749-4486.2012.02454.x.
    1. Sanabria A, Carvalho AL, Silver CE, Rinaldo A, Shaha AR, Kowalski LP, et al. Routine drainage after thyroid surgery–a meta-analysis. J Surg Oncol. 2007;96:273–280. doi: 10.1002/jso.20821.
    1. Loyo M, Tufano RP, Gourin CG. National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope. 2013;123:2056–2063. doi: 10.1002/lary.23923.
    1. Lee YS, Nam KH, Chung WY, Chang HS, Park CS. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci. 2010;25:541–545. doi: 10.3346/jkms.2010.25.4.541.
    1. Verloop H, Louwerens M, Schoones JW, Kievit J, Smit JW, Dekkers OM. Risk of hypothyroidism following hemithyroidectomy: systematic review and meta-analysis of prognostic studies. J Clin Endocrinol Metab. 2012;97:2243–2255. doi: 10.1210/jc.2012-1063.
    1. D'Orazi V, Sacconi A, Trombetta S, Karpathiotakis M, Pichelli D, Di Lorenzo E, et al. May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score. BMC Surg. 2019;18:116. doi: 10.1186/s12893-018-0447-7.
    1. Ramouz A, Rasihashemi SZ, Daghigh F, Faraji E, Rouhani S. Predisposing factors for seroma formation in patients undergoing thyroidectomy: cross-sectional study. Ann Med Surg (Lond) 2017;23:8–12. doi: 10.1016/j.amsu.2017.09.001.
    1. Zanocco K, Heller M, Elaraj D, Sturgeon C. Is subtotal thyroidectomy a cost-effective treatment for Graves disease? A cost-effectiveness analysis of the medical and surgical treatment options. Surgery. 2012;152:164–172. doi: 10.1016/j.surg.2012.02.020.
    1. Shrime MG, Goldstein DP, Seaberg RM, Sawka AM, Rotstein L, Freeman JL, et al. Cost-effective management of low-risk papillary thyroid carcinoma. Archives of otolaryngology--head & neck surgery. 2007;133:1245–53. 10.1001/archotol.133.12.1245.
    1. Esnaola NF, Cantor SB, Sherman SI, Lee JE, Evans DB. Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis. Surgery. 2001;130:921–930. doi: 10.1067/msy.2001.118370.
    1. Yip L, Farris C, Kabaker AS, Hodak SP, Nikiforova MN, McCoy KL, et al. Cost impact of molecular testing for indeterminate thyroid nodule fine-needle aspiration biopsies. J Clin Endocrinol Metab. 2012;97:1905–1912. doi: 10.1210/jc.2011-3048.
    1. Neudeck MR, Steinert H, Moergeli H, Weidt S, Seiler A, Strobel K, et al. Work ability and return to work in thyroid cancer patients and their partners: a pilot study. Psychooncology. 2017;26:556–559. doi: 10.1002/pon.4154.
    1. Ketterl TG, Syrjala KL, Casillas J, Jacobs LA, Palmer SC, McCabe MS, et al. Lasting effects of cancer and its treatment on employment and finances in adolescent and young adult cancer survivors. Cancer. 2019;125:1908–1917. doi: 10.1002/cncr.31985.
    1. Leso V, Vetrani I, De Cicco L, Cardelia A, Fontana L, Buonocore G, et al. The impact of thyroid diseases on the working life of patients: a systematic review. Int J Environ Res Public Health. 2020;17. 10.3390/ijerph17124295.
    1. Waissi F, Kist JW, Lodewijk L, de Wit AG, van der Hage JA, van Dalen T, et al. Fast-track radioiodine ablation therapy after thyroidectomy reduces sick leave in patients with differentiated thyroid cancer (FASTHYNA Trial) Clin Nucl Med. 2019;44:272–275. doi: 10.1097/RLU.0000000000002420.
    1. Borget I, Corone C, Nocaudie M, Allyn M, Iacobelli S, Schlumberger M, et al. Sick leave for follow-up control in thyroid cancer patients: comparison between stimulation with Thyrogen and thyroid hormone withdrawal. Eur J Endocrinol. 2007;156:531–538. doi: 10.1530/EJE-06-0724.
    1. Emmanouilidis N, Schrem H, Winkler M, Klempnauer J, Scheumann GF. Long-term results after treatment of very low-, low-, and high-risk thyroid cancers in a combined setting of thyroidectomy and radio ablation therapy in euthyroidism. Int J Endocrinol. 2013;2013:769473. doi: 10.1155/2013/769473.
    1. Luster M, Felbinger R, Dietlein M, Reiners C. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid. 2005;15:1147–1155. doi: 10.1089/thy.2005.15.1147.
    1. Nijhuis TF, van Weperen W, de Klerk JMH. Kosten samenhangend met de onttrekking van schildklierhormoontherapie bij de follow-up van het gedifferentieerde schildkliercarcinoom. Tijdschr Nucl Geneeskd. 1999;21:98–100.
    1. Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid. 1997;7:613–619. doi: 10.1089/thy.1997.7.613.
    1. Park JH, Park EC, Park JH, Kim SG, Lee SY. Job loss and re-employment of cancer patients in Korean employees: a nationwide retrospective cohort study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26:1302–1309. doi: 10.1200/JCO.2007.14.2984.
    1. Tamminga SJ, Bultmann U, Husson O, Kuijpens JL, Frings-Dresen MH, de Boer AG. Employment and insurance outcomes and factors associated with employment among long-term thyroid cancer survivors: a population-based study from the PROFILES registry. Qual Life Res. 2016;25:997–1005. doi: 10.1007/s11136-015-1135-z.
    1. Wale A, Miles KA, Young B, Zammit C, Williams A, Quin J, et al. Combined (99m)Tc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur J Nucl Med Mol Imaging. 2014;41:105–115. doi: 10.1007/s00259-013-2546-0.

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