Abstract: Papillary thyroid microcarcinoma (PTMC) has indolent features and low mortality. Recently, active surveillance (AS) instead of early surgery (ES) has been introduced as one treatment option but economical preference has not been established. The study objective was to systemically review the literature relating to cost-effectiveness of AS compared to ES for PTMC. Keywords were selected through PICO (Population, Intervention, Comparison, and Outcomes) tools. The search was conducted using PubMed, Cochrane, EMBASE, and Elsevier databases. Papers that had irrelevant titles were written in foreign languages, or had no original results were excluded. Out of the 62 papers extracted, five relevant to the subject matter of this study were identified. Three papers made their own decision models and proceeded with cost-effectiveness analysis (CEA), but the remaining two simply compared costs rather than cost-effectiveness. In terms of cost-effectiveness, three papers preferred AS, one preferred ES, and one preferred neither. The major differences in the CEA might arise from variations in each country’s medical insurance system, the utility score systems, and decision models used. In subgroup analysis, two papers preferred AS to ES for patients at a younger age at diagnosis in terms of cost-effectiveness as well as tumor biological characteristics. Although AS has been generally more cost-effective than ES in previous publications, younger age at diagnosis could be one factor contributing to preference for ES. The CEA of prospective cohorts based on the decision model and utility score for thyroid cancer should be undertaken to confirm the cost-effectiveness of AS.

Keywords: cost-effectiveness analysis, papillary thyroid cancer, quality of life, active surveillance, endocrine surgical procedures


中文翻译：

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主动监测与早期手术治疗小乳头状甲状腺癌的成本效益分析：系统评价

摘要：乳头状甲状腺微小癌 (PTMC) 具有惰性特征和低死亡率。最近，主动监测 (AS) 代替早期手术 (ES) 被引入作为一种治疗选择，但尚未确定经济偏好。该研究的目标是系统地回顾与 AS 与 ES 相比对 PTMC 的成本效益相关的文献。关键词是通过 PICO（人口、干预、比较和结果）工具选择的。搜索使用 PubMed、Cochrane、EMBASE 和 Elsevier 数据库进行。用外文写的，或者没有原创结果的论文被排除在外。在提取的 62 篇论文中，确定了与本研究主题相关的 5 篇。三篇论文做出了自己的决策模型并进行了成本效益分析（CEA），但剩下的两个只是比较成本而不是成本效益。在性价比方面，三篇论文更喜欢AS，一篇更喜欢ES，一篇都不喜欢。CEA 的主要差异可能源于每个国家的医疗保险制度、效用评分系统和所使用的决策模型的差异。在亚组分析中，两篇论文在成本效益和肿瘤生物学特征方面更倾向于对诊断时年龄较小的患者使用 AS 而非 ES。尽管在以前的出版物中 AS 通常比 ES 更具成本效益，但诊断时的年龄较小可能是导致偏爱 ES 的一个因素。应根据甲状腺癌的决策模型和效用评分进行前瞻性队列的 CEA，以确认 AS 的成本效益。

关键词：成本效益分析，甲状腺乳头状癌，生活质量，主动监测，内分泌外科手术