ETA2023 Poster Presentations Nodules 2 (9 abstracts)
A pharmacoeconomic analysis from italian guidelines for the management of non-hyperfunctioning, bening thyroid nodules
Irene Samperi 1 , Michele Basile 2 , alessandro scoppola 3 , Agnese Persichetti 4 , Roberto Attanasio 5 , Agostino Paoletta 6 , Rosella Saulle 7 , Simona Vecchi 7 , Roberto Novizio 8 , Enrico Papini 9 & on behalf of all members of guideline panel 10
1Endocrinologia, Asl Novara; 2Alta Scuola DI Economia e Management Dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Roma; 3Uosd Endocrinologia, Asl Roma 1, Ospedale S. Spirito; 4Department of Molecuar Medicine, Sapienza University of Rome, Regina Apostolorum, Rome, Italy; 5Division of Endocrinology, Debrecen, Hungary; 6Endocrinologia, Ulss6 Euganea, Padova; 7Dipartimento DI Epidemiologia del S.S.R.- Asl Roma1 Regione Lazio; 8Endocrinologia, Ucsc - Rome, Italy; 9Department of Endocri. & Metabol. Disease, Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy, Ospedale Regina Apostolorum, Albano Roma, Italy; 10All in Italy
Background: Thyroid nodules are the most common endocrine pathology. Due to the widespread use of imaging modalities, mostly ultrasound, the incidental finding of thyroid nodules has increased, reaching a prevalence of 50-60% in adults. Diagnostic definition and therapeutic interventions represent thus an increasing cost for health system. In patient with benign thyroid nodule causing local symptoms, hemithyroidectomy with isthmectomy or total thyroidectomy are the recommended primary surgical treatment, depending on unilateral or bilateral disease localization, respectively. For patients with symptomatic, solid, benign, single, or dominant thyroid nodule, thermal ablation may be considered as an alternative to surgery.
Aim: To produce economic evidence in the context of the definition of guideline for the management of non-hyperfunctioning, benign thyroid nodules in Italian healthcare setting.
Methods: A systematic literature review and a survey among the guideline panel members were performed to address drivers that contribute to total cost of each therapeutic option.
Results: In Italy, during the last 20 years, an average of 40,000 thyroid surgeries (total or partial) have been performed each year, about one quarter of them for malignant diseases. One third of those operated on for a benign disease suffered from uninodular goiter or multinodular goiter with a clearly dominant nodule. The number of patients eligible for percutaneous ablative treatment could thus range from 8,000 to 10,000/year. The individual reimbursement by national health system (NHS) for thyroid surgery amounts to C– 4211. Savings for each ablative treatment replacing hemithyroidectomy/total thyroidectomy can be estimated at C– 2651 (the difference between C– 4211 cost of thyroid surgery and C– 1560 of an ablative treatment ). Annual savings for the NHS would fluctuate from a minimum of C– 7,953,000 to C– 23,859,000 when ablative treatments will be fully operational.
Conclusions: While thyroid surgery is a standardized therapeutic procedure, the more recently introduced minimally invasive therapies with thermal ablation are less standardized. On considering the cost-utility profile, a reduction in the annual number of surgical interventions for benign nodular pathology (currently the main cause of thyroid surgery) is foreseeable in favor of minimally invasive treatments performed in day-hospital, sparing costs of operating room and hospital stay. This change should also generate a reduction in the occupation rate of surgical beds and faster accessibility to surgical departments for oncological operations.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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