While recombinant human TSh (rhTSH) avoids the transient thyroid hormone withdrawal (THW) deterioration of health-related qualify of life (HRQoL) in patients with thyroid cancer, it is not cost-effective and would likely not be used in practice, according to an article published online ahead of print in the Journal of Clinical Oncology.
In the phase 3 ESTIMABL trial, the thyroid ablation rate was equivalent for both thyroid hormone withdrawal (THW) and rhTSH methods and the two iodine-131 (131I or 3.7 GBq).
A total of 752 patients with thyroid cancer were assessed, from the time of random assignment to a follow-up visit at 8±2 months. Resource use (hospitalization for 131I administration, rhTSH, sick leave, and transportation) was collected prospectively.
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At 131I administration, patients experienced a clinically significant deterioration of HRQoL with THW, but it remained stable with rhTSH. The deterioration was transient with no difference 3 months later. rhTSH was more effective than THW in terms of quality-adjusted life years, but was more expensive.
The use of 1.1 GBq of 131I instead of 3.7 GBq reduced per-patient costs by $1,018 but with slightly decreased efficacy.
- Borget I, Bonastre J, Catargi B, et al. Quality of life and cost-effectiveness assessment of radioiodine ablation strategies in patients with thyroid cancer: results from the randomized phase III ESTIMABL trial. J Clin Oncol. 2015. [epub ahead of print]. doi: 10.1200/JCO.2015.61.6722.