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Radioiodine ablation in thyroid cancer patients: comparison of length and cost of hospital stay between preparation by 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.

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    • "The ability to substitute pituitary TSH by recombinant TSH uncouples the radio ablative treatment (RAT) from hypothyroidism and facilitates RAT in euthyroidism under full-scale L-T 4 substitutive medication. The socioeconomic advantages of RAT in euthyroidism are a sustained quality-of-life and a significantly reduced number of sick-leave days [4] [8] [9] and it has been shown that rhTSH preconditioning is as effective and safe as preconditioning by hypothyroidism [10] [11] [12] [13]. Here we present long-term follow-up data of a randomized clinical trial comparing the efficacy of RAT after preconditioning by rhTSH with hypothyroidism. "
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    ABSTRACT: Introduction. Differentiated thyroid cancer treatment usually consists of thyroidectomy and radio ablation in hypothyroidism 4-6 weeks after surgery. Replacing hypothyroidism by recombinant human thyroid stimulating hormone can facilitate radio ablation in euthyroidism within one week after surgery. The outcome of this approach was investigated. Methods. This is a prospective randomized trial to compare thyroidectomy and radio ablation within a few days after preconditioning with recombinant human thyroid stimulating hormone versus thyroidectomy and radio ablation separated by four weeks of L-T4 withdrawal. Tumors were graded into very low-, low- , or high-risk tumors. Recurrence-free survival was confirmed at follow-up controls by neck ultrasound and serum thyroglobulin. Suspected tumor recurrence was treated by additional radio ablation or surgery. Quality-of-life questionnaires with additional evaluation of job performance and sick-leave time were used in all patients. Results. Radio ablation in euthyroidism in quick succession after thyroidectomy did not lead to higher tumor recurrence rates of differentiated thyroid cancers in any risk category and was significantly advantageous with respect to quality-of-life (P < 0.001), sick-leave time (P < 0.001), and job performance (P = 0.002). Conclusion. Recombinant human thyroid stimulating hormone can be used safely and with good efficacy to allow radio ablation under sustained euthyroidism within one week after thyroidectomy.
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