Cost-Effectiveness of Papillary Thyroid Microcarcinoma Treatment Pathways in Older Adults - research study

Sep 29, 2026

Decision analysis evaluates cost-effectiveness among three papillary thyroid microcarcinoma (PTMC) treatment pathways for older adults: radiofrequency ablation (RFA), active surveillance (AS), and surgery options. A Markov model with a 10-year horizon compares outcomes using QALYs and literature-derived costs and probabilities, with time-trade-off QALY weights. Probabilistic sensitivity analysis tests uncertainty in QALY weights and progression probabilities. Results show RFA is cost-effective versus AS (ICER $23,821/QALY), while total thyroidectomy is strongly dominated by partial thyroidectomy, and partial thyroidectomy by RFA.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background and Aim

Methods: Markov model and assumptions

Cost-effectiveness Results

Dominance and incremental cost-effectiveness

Sensitivity analyses (1-way and probabilistic)

Conclusion

Innovation in Aging, 2025, Vol. 9, No. S2 1223 – radiofrequency ablation (RFA), partial thyroidectomy (PT), and total thyroidectomy (TT)– compared to AS. The base case was a 70-year-old patient with PTMC without high-risk features. Cost-effectiveness was estimated with a 10-year horizon and a willingness-to-pay threshold of $50,000/quality-adjusted life-year (QALY) . Costs and outcome probabilities were derived from the literature. QALY weights for common PTMC-related health states were derived using time trade-off. Probabilistic sensitivity analysis (PSA) accounted for parameter uncertainty for QALY weights, AS & RFA disease progression probabilities, and treatment selection following disease progression. In this model, TT was strongly dominated by PT, and PT by RFA. RFA was cost-effective compared to AS, with an incremental cost-effectiveness ratio of $23,821/QALY. A 1-way sensitivity analysis demonstrated that RFA remained more cost-effective than AS for post-RFA disease progression rates up to 6.3 times that of AS. The PSA demonstrated RFA and AS were optimal in 58% and 36% of model iterations, respectively. In conclusion, for older adults with PTMC, RFA and AS are cost-effective relative to surgery; RFA is more cost-effective thanAS, independent of its degree of disease progression risk reduction. Abstract citation ID: igaf122.4091 COST-EFFECTIVENESS OF PAPILLARY THYROID MICROCARCINOMA TREATMENT PATHWAYS IN OLDER ADULTS Rebecca Kowalski1, Seth Rabinowitz1, Julia Slejko2, C. Daniel Mullins2, and Yinin Hu3, 1. University of Maryland, Baltimore, Maryland, United States, 2. University of Maryland School of Pharmacy, Baltimore, Maryland, United States, 3. University of Maryland School of Medicine, Baltimore, Maryland, United States Papillary thyroid microcarcinomas (PTMCs) are sub-centimeter cancers with an excellent prognosis. Cancer outcomes are similar across four common treatment pathways, making cost-effectiveness an important factor for treatment selection. In this decision analysis study, we hypothesized that compared to alternative strategies, active surveillance (AS) would be cost-effective for PTMC treatment among older adults. A Markov model was constructed to evaluate the incremental cost-effectiveness of three PTMC treatment pathways

FAQs

Which PTMC treatment pathways were compared in the study?

The study compared radiofrequency ablation (RFA), active surveillance (AS), and surgery pathways including partial and total thyroidectomy.

How was cost-effectiveness estimated and over what time horizon?

A Markov model estimated incremental cost-effectiveness over a 10-year horizon using QALYs, with costs and outcome probabilities drawn from the literature.

What were the main findings for older adults with PTMC?

RFA was cost-effective compared with AS (ICER $23,821/QALY). Total thyroidectomy was strongly dominated by partial thyroidectomy, and partial thyroidectomy was dominated by RFA.

Sep 29, 2026

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