Background: Papillary thyroid microcarcinoma (PMC), is a subtype of thyroid cancer that may be approached with active surveillance (AS) rather than immediate surgery. AS reduces complication rates and may reduce health care cost. This study aims to analyze complication rates of thyroid surgery, PMC recurrence and survival rates. Additionally, the costs of surgery versus hypothetical AS for PMC are compared in an Australian cohort.
Methods: PMC patients were included from a prospectively collected surgical cohort of patients treated for papillary thyroid cancer between 1985 and 2017. Primary outcome was the complications of thyroid surgery, recurrence free survival, overall survival and the cost of surgical treatment and AS.
Results: In total 349 PMC patients with a median age of 48 years (range, 18-90 years). Permanent surgical complications rate was 3.7%. Postoperative RAI did not reduce recurrence free survival (P=0.3). Total costs of surgical treatment was A$10,338, whereas hypothetical AS was at a yearly cost of A$722. We estimate that the cost of one surgical PMC treatment equals approximately 17.0 years of AS.
Conclusion: Surgery may have a long-term economic advantage for younger Australian PMC patients who are likely to require more than 17.0 years of follow-up in an AS scheme.