Article

Length and cost of hospital stay of radioiodine ablation in thyroid cancer patients: comparison between preparation with thyroid hormone withdrawal and thyrogen

Detpartment of Health Economics, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805, Villejuif, France.
European journal of nuclear medicine and molecular imaging (Impact Factor: 5.22). 05/2008; 35(8):1457-63. DOI: 10.1007/s00259-008-0754-9
Source: PubMed

ABSTRACT Treatment of thyroid cancer consists of thyroidectomy and radioiodine ablation following thyroid-stimulating hormone (TSH) stimulation. Similar ablation rates were obtained with either thyroid hormone withdrawal (THW) or rhTSH. But with rhTSH, the elimination of radioiodine is more rapid, thus reducing its whole-body retention and potentially resulting in a shorter hospital stay. The aim of this study was to assess the financial impact of a reduced length of hospital stay with the use of rhTSH.
This was a case-control study of thyroid cancer patients treated postoperatively with 3,700 MBq (100 mCi) radioiodine; 35 patients who received rhTSH were matched with 64 patients submitted to THW according to covariates influencing radioiodine retention. The length of hospitalization (LOH) was estimated for each method according to the threshold of radioiodine retention below which the patient can be discharged from the hospital. The economic analysis was conducted from a hospital perspective. Simulations were performed.
For a threshold of 400 MBq, the LOH was 2.4 days and 3.5 days with rhTSH and THW, respectively, and the cost for an ablation stay was, respectively, 2,146 and 1,807 . In the French context, 57% of the acquisition cost of rhTSH was compensated by the reduction of the length of hospitalization.
By increasing the iodine excretion, rhTSH allows a shorter hospitalization length, which partially compensates its acquisition cost.

3 Followers
 · 
76 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The concept of individualized therapy is rapidly gaining recognition in the management of patients with differentiated thyroid cancer (DTC). This Review provides an overview of the most important elements of this paradigm shift in DTC management and discusses the implications for clinical practice. In the majority of patients with DTC who have an inherently good prognosis, the extent of surgery, the dosage of (131)I therapy and the use of levothyroxine therapy are all aspects suitable for individualization, on the basis of both the stage of disease and the response to treatment. In individuals with advanced disease, newer imaging techniques, advances in (131)I therapy and the use of targeted molecular therapies (such as multitargeted kinase inhibitors) have provided new options for the personalized care of patients, for whom until recently no effective therapies were available. Individualized therapies could reduce adverse effects, including the sometimes debilitating hypothyroidism that used to be required before initiation of (131)I treatment, and major salivary gland damage, a common and unpleasant side effect of (131)I therapy. Highly individualized interdisciplinary treatment of patients with DTC might lead to improved outcomes with reduced severity and frequency of complications and adverse effects. However, in spite of ongoing research, personalized therapies remain in their infancy.
    Nature Reviews Endocrinology 07/2014; 10(9). DOI:10.1038/nrendo.2014.100 · 12.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of review Radioactive iodine (RAI) is administered postoperatively to the majority of thyroid cancer patients. No available study has demonstrated any benefit in low-risk patients. Recent findings RAI should be used selectively in low and intermediate-risk patients, based on the surgical and pathological reports and on postoperative serum thyroglobulin level and neck ultrasonography. When used, a low activity (30 mCi) is administered following recombinant human thyrotropin stimulation. High-risk patients are treated with a high activity of RAI (100 mCi or more). Summary RAI is not administered in many low-risk patients who can be reliably followed up with serum thyroglobulin determination on L-thyroxine treatment and neck ultrasonography. RAI may be administered in case of abnormality, and this delay will not reduce the chance of cure.
    Current Opinion in Endocrinology Diabetes and Obesity 08/2014; 21(5). DOI:10.1097/MED.0000000000000100 · 3.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Initial treatment of differentiated thyroid cancer is based on a total thyroidectomy and in many cases on the administration of radioactive iodine. Following total thyroidectomy, radioactive iodine is given, based on the primary tumor characteristics. In case of a very low-risk of recurrence it is recommended not to give radioactive treatment. In case of intermediate risk patients, two randomized prospective studies (ESTIMABL and HILO) have shown that an activity of 1.1 GBq (30 mCi) given after recombinant human thyroid stimulating hormon (rhTSH) was adequate. A further step is taken towards less treatment has now been undertaken with the ESTIMABL2 study, a prospective randomized study comparing a treatment with 1.1 GBq (30 mCi) of radioactive iodine treatment to follow-up without ablation. In case of high-risk patients or in case of persistent disease a high activity of radioactive iodine is given after TSH stimulation. In case of distant metastases, cure is obtained with radioactive iodine in 1/3 of the patients. In the absence of cure, patients are classified as refratory to radioactive iodine and may benefit from tyrosine kinase inhibitors.
    Medecine Nucleaire 05/2014; DOI:10.1016/j.mednuc.2014.03.132 · 0.16 Impact Factor