How global age of rhTSH fits into local cost-benefits

Objectives To streamline the preparation of thyroid cancer patients for radioidine ablation on the basis of simple cost-benefit estimation, despite the fact that there has been actually no evidence that either maximal absorbed dose rate or total absorbed dose per unit administered therapeutic activity of I-131 has clear benefits over the elevation of thyroid-stimulating hormone concentration by either thyroid hormone withdrawal (THW) or injection of recombinant human thyroid-stimulating hormone (rhTSH).

Methods National statistical and billing data, together with quantitative clinical data from our patients and from the literature were used.

Results The national incidence rate of thyroid cancer as a primary site is currently 11.4. The cost of rhTSH has been roughly twice the national average net pay per month, and the estimated duration of sick-leave is about ten days less in case of rhTSH-aided patient preparation. In most of the cases thyroid remnant ablation procedure at recommended TSH concentration level may be completed within three weeks following total thyroidectomy and/or THW.

Conclusions It appears that high rates of thyroid remnant ablation and low recurrence rates are achievable in totally thyroidectomized patients without significantly compromising the patient’s quality of life by prolonged hypothyroidism. These results should be achievable by single administration of moderate I-131 activity and by thyroid hormone supplementation started or restarted about 1-3 weeks after surgery or thyroid hormone withdrawal. If the costs of rhTSH- vs. THW-aided radioiodine therapy in certain countries or certain patients are much higher, such an approach seems reasonable