Cost-utility analysis of rhTSH for differentiated thyroid carcinoma from a societal perspective

Abstract

Objective: The treatment of individuals with differentiated thyroid carcinoma (DTC) includes thyroidectomy followed by radioiodine (¹³¹I) ablation. For treatment effectiveness, elevated TSH levels are essential, which can be achieved through thyroid hormone withdrawal for 4–6 weeks after thyroidectomy. However, considering the limitations of withdrawal, the use of recombinant human TSH (rhTSH) could be an alternative. This study aims to evaluate whether rhTSH is cost-effective compared to the induction of endogenous hypothyroidism (IHE) by levothyroxine withdrawal, from the societal perspective. Methods: A cost-utility analysis was conducted following the Brazilian Ministry of Health's guidelines, using a Markov model with four health states (pre-ablation, ablation, post-ablation, and recovered). A 17-week time horizon (weekly cycles) was adopted from the societal perspective, including direct and indirect costs. Effectiveness was measured in quality-adjusted life years (QALYs). Probabilistic and deterministic sensitivity analyses were also performed. Results: The results showed that rhTSH treatment provides greater clinical benefit (0.2687 vs. 0.2602 QALYs) at an incremental cost (R$ 4,762 vs. R$ 4,135), with an incremental cost-utility ratio (ICUR) of R$ 73,662/QALY gained. The most impactful factors were the cost of rhTSH, lost workdays, and utility values. Conclusion: The findings suggest that rhTSH offers greater clinical benefits, spite of additional costs and could be a cost-effective alternative depending on the willingness-to-pay threshold for society's perspective. Brazil did not recommend a willingness-to-pay threshold for this perspective and if it coincided with the threshold adopted for the SUS, rhTSH would be cost-effective for a threshold of R$120,000/QALY gained.