Low-Risk Papillary Thyroid Cancer: Treatment De-Escalation and Cost Implications

Introduction: The American Thyroid Association (ATA) updated consensus guidelines in 2015 for radioactive iodine (RAI) and resection for low-risk papillary thyroid cancer. The objective of this study was to describe the evolution of institutional practice patterns and estimate the cost implications of these trends.Materials and methods: Patients with cT1-T2N0 papillary thyroid cancer were identified via an institutional tumor registry. Incidences of total thyroidectomy or RAI were tracked longitudinally using cumulative sum. Real-world costs for RAI and each surgical encounter were adjusted for inflation and standardized to national average costs from National Inpatient Sample cost data.Results: Sixty-one patients met inclusion criteria between 2007 and 2018. Among these, 28 patients underwent total thyroidectomies and received RAI treatments based on criteria predating the 2015 ATA guidelines. Cumulative sum revealed significant decreases in the rate of total thyroidectomy following May 2015 (15.8% versus 59.5%, P = 0.002) and RAI following March 2013 (3.0% versus 32.1%, P = 0.002). There were no locoregional recurrences in either period. The average cost savings attributable to these institutional practice changes was $1580 per patient.Conclusions: De-escalation in surgical and RAI utilization for low-risk papillary thyroid cancer according to 2015 ATA guidelines is associated with a substantial decrease in real-world costs.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study investigated the impact of the American Thyroid Association's updated guidelines on the practice patterns of low-risk papillary thyroid cancer treatment. The analysis of data revealed a decrease in the utilization of surgery and radioactive iodine treatment for low-risk cases in accordance with the guidelines, and these changes resulted in significant cost savings.