ECONOMIC IMPACT OF SURGICAL DE-ESCALATION: TRENDS IN DIFFERENTIATED THYROID CANCER MANAGEMENT USING REAL-WORLD DATA FROM 2014 TO 2022
Author(s)
Lou-Anne Peretti1, Livia Lamartina, MD2, Sophie Leboulleux, Pre3, Isabelle BORGET, PharmD, PhD4.
1Student, Master2 Market-Access and Economic Evaluation, Brétigny-sur-Orge, France, 2Gustave Roussy, Villejuif, France, 3Hopitaux Universitaires de Genève, Geneva, Switzerland, 4Master2 Market-Access and Economic Evaluation, ORSAY, France.
1Student, Master2 Market-Access and Economic Evaluation, Brétigny-sur-Orge, France, 2Gustave Roussy, Villejuif, France, 3Hopitaux Universitaires de Genève, Geneva, Switzerland, 4Master2 Market-Access and Economic Evaluation, ORSAY, France.
OBJECTIVES: Management of non-refractory radioiodine differentiated thyroid cancer (DTC) has progressively shifted toward therapeutic de-escalation. Since 2015, international guidelines (ATA, ETA, ESMO) have advocated for lobectomy over total thyroidectomy for low-risk patients. However, the real-world economic impact remains poorly documented. To address this gap, we evaluated surgical trends and their associated costs, from a national health perspective, using the national healthcare database (SNDS), capturing claims for 99% of the French population.
METHODS: Adult patients with incident non-refractory DTC were identified in 2014, 2018 and 2022 in the SNDS, (ICD-10 codes C73 and D09.3). Only incident cases were retained, excluding patients with thyroid cancer within two years prior to the index date (date of first hospitalization or start of long-term disease). Patients with anaplastic, medullary or refractory DTC were excluded, using procedure codes and drug reimbursement data. Surgeries were categorized as lobectomy or total thyroidectomy, recording associated costs for all procedures within ±3 days. Temporal trends in treatment patterns and surgical costs were assessed across the three study years.
RESULTS: A total of 10615, 9175 and 8786 incident patients, diagnosed with a DTC were identified in 2014, 2018 and 2022, respectively. Over the study period, surgical management shifted toward less extensive procedures: the proportion of total thyroidectomies decreased from 70,6% in 2014 to 62,7% in 2022, while the proportion of lobectomies increased from 7,8% in 2014, 11,8% in 2018 and to 18,3% in 2022. The median surgical cost per patient decreased from 4122€ in 2014 to 3843€ in 2018 and increased slightly to 3916€ in 2022.
CONCLUSIONS: These findings demonstrate a clear surgical de-escalation in the management of non-refractory DTC, driven by increased lobectomy use, associated with decreased surgical costs from 2014 to 2018. The 2022 value can be explained by the revaluation of hospital tariff and the COVID crisis.
METHODS: Adult patients with incident non-refractory DTC were identified in 2014, 2018 and 2022 in the SNDS, (ICD-10 codes C73 and D09.3). Only incident cases were retained, excluding patients with thyroid cancer within two years prior to the index date (date of first hospitalization or start of long-term disease). Patients with anaplastic, medullary or refractory DTC were excluded, using procedure codes and drug reimbursement data. Surgeries were categorized as lobectomy or total thyroidectomy, recording associated costs for all procedures within ±3 days. Temporal trends in treatment patterns and surgical costs were assessed across the three study years.
RESULTS: A total of 10615, 9175 and 8786 incident patients, diagnosed with a DTC were identified in 2014, 2018 and 2022, respectively. Over the study period, surgical management shifted toward less extensive procedures: the proportion of total thyroidectomies decreased from 70,6% in 2014 to 62,7% in 2022, while the proportion of lobectomies increased from 7,8% in 2014, 11,8% in 2018 and to 18,3% in 2022. The median surgical cost per patient decreased from 4122€ in 2014 to 3843€ in 2018 and increased slightly to 3916€ in 2022.
CONCLUSIONS: These findings demonstrate a clear surgical de-escalation in the management of non-refractory DTC, driven by increased lobectomy use, associated with decreased surgical costs from 2014 to 2018. The 2022 value can be explained by the revaluation of hospital tariff and the COVID crisis.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD97
Topic
Economic Evaluation, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Oncology