OBJECTIVES: Recently, active surveillance (AS), rather than early surgery (ES) has been introduced for the management of papillary thyroid microcarcinoma (PTMC) for its indolent features and low mortality. However, economical preference has not been established and the result of researches are different according to each country’s medical system. We built the CEA model based on real world practice scenario with Korean medical cost system and the utility score from Korean cohort.

METHODS: Markov model was constructed for comparing the cost-effectiveness between AS and ES. The reference case was a 40-year-old patient with diagnosed, low-risk PTMC. Costs and transition probabilities were derived from previous clinical studies conducted on Korean population. The incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated. The willingness-to-pay (WTP) threshold was set at $100,000/quality-adjusted life year (QALY) gained. The sensitivity analyses were conducted considering the uncertainty in the model’s variables

RESULTS: From the base scenario, the cumulative costs and effectiveness were both higher in ES than AS. The ICER for ES against AS? were $6619.86/QALY that is lower than WTP. The NMB difference between AS and ES has grown over the stage. ($5980 at the first stage and $300290 at the last stage)

CONCLUSIONS: In summary, in the current Korean medical system, ES is more cost-effective than AS, and ES is more cost-effective as it is diagnosed at young age and follow-up for a long time.