Endocrine Abstracts

Background: Thyroid nodules prevalence is high in adult population, approaching 60% in women and older people. Most thyroid nodules are benign and asymptomatic. However, a not negligible part of them causes compressive symptoms and/or cosmetic concerns and need treatment. In the last decades, minimally invasive treatments of the thyroid (MITT) have been proposed in clinical practice as reliable cost-effective alternative to surgery in patients with symptomatic benign thyroid nodules (SBTNs).

Aim: Cost-minimization analysis comparing direct, indirect and intangible costs of radiofrequency (RFA) and laser thermal ablation (LTA) with traditional surgery in patients with SBTNs.

Methods: Data of patients treated by MITT for SBTNs from October 1st 2019 to September 30th 2022 in a single Italian Center were analyzed. Costs were compared to those of traditional surgery reported in the 2022 Associazione Medici Endocrinologi Guidelines on the Management of SBTNs.

Results: 157 MITT of SBTNs were performed in 148 patients, 114 females and 34 males (mean age: 59 yrs). Before MITT, mean thyroid nodule volume was 19 ml; 1 year after MITT, volume reduction rate >50% and symptom relief were achieved in 89% and 93% of patients, respectively. No major complications occurred. Adding up pre-operative, operative and post-operative costs, total direct costs per single procedure are the following: 1361.43 € for LTA, using one optic fiber; 1761.43 € for LTA, using two optic fibers; 1968.53 € for RFA; 3338.39 € for hemithyroidectomy plus isthmectomy; 4034.99 € for total thyroidectomy. Surgery was impactful on direct-i.e., preoperative, operative and postoperative-costs, due to longer operating room occupation time and hospital stay. Overall, a total saving for the Italian National Health Service of 285, 377.15 € has been obtained treating the 148 patients by MITT instead of surgery. MITT was advantageous also for indirect costs-i.e., those related to "loss of productivity" caused by time off work-, for both the self-employed workers and the Government, the latter saving 53, 838.50 €. Intangible costs, related to patients’ quality of life-e.g., residual surgical scar, convalescence, and life-long intake of L-Thyroxine replacement therapy-were all in favor of MITT.

Conclusion: This real-life cost-minimization analysis demonstrates that LTA and RFA are safe and cost-effective procedures for the treatment of SBTNs. In our 3 years experience, adding the savings of 285, 377.15 € for direct costs to those of 53.838, 50 € for indirect costs, in total 339, 215.65 € were saved. The saving concern patients, the National Health System and the Government.