Pharmacoeconomic analysis of methods for diagnosis of relapse and/or metastases of differentiated thyroid cancer
Keywords:thyroid cancer, relapse, diagnostics, pharmacoeconomics
The pharmacoeconomic analysis the two schemes of diagnosing relapse/metastases of thyroid cancer after treatment has been conducted. The routine diagnostic scheme consists of three stages: the neck ultrasound, computed tomography of the chest (if there is a negative result of ultrasound), scintigraphy with 131I (if there is a negative result of CT). An alternative scheme consists of four stages: the neck ultrasound, scintigraphy radiopharmaceutical 99mTc- (V) DMSA, chest CT, scintigraphy with 131I. The cost-effectiveness analysis and a decision-tree model have been used to compare two schemes. The criterion of efficiency of the diagnostic test of relapse was the number of patients with the true-positive result. Assumptions of the model are if one method gives a positive result, another method should not be used. If one method gives a negative result, another method should be used to exclude false-negative results. The sequence of methods is determined by their cost: at first a cheaper method of diagnosis is used, then the more expensive is applied. The sources of data for modeling are the results of clinical examination of 190 patients with thyroid cancer in the S. P. Grigoriev Institute of Medical Radiology of the Academy of Medical Sciences of Ukraine in 2012-2014. The costs for each diagnostic procedure, the cost of equipment depreciation, labour remuneration of a physician-researcher were taken into account. According to the results of the study the total costs for the diagnosis of relapse in 100 patients with a routine diagnostic scheme is 94849.5 UAH, the CER coefficient is 977,8 UAH. The total costs of using alternative diagnostic schemes is 77743.5 UAH, the CER coefficient is 793,3 UAH. (18% less). Cost reduction is achieved due to the use of a cheaper method 99mTc- (V) DMSA instead 131І for the majority of patients. The alternative diagnostic scheme of relapse of thyroid cancer with 99mTc- (V) DMSA allows to spend financial resources more efficiently.
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