Increased inappropriate radioactive iodine therapy carries extra costs, patient risks

The rate of radioactive iodine therapy given to patients needlessly and against recommendations increased during more than a decade, according to findings published in JAMA Internal Medicine.

“Our study demonstrates that nearly one-fourth of patients with thyroid cancer may receive unnecessary radioactive iodine treatment,” the researchers wrote.

The average cost burden accrued by patients with papillary thyroid microcarcinoma was nearly $1,800 per year, which the researchers contend is actually an underestimation.

“We could not include costs associated with complications from … therapy and quality of life changes and … our reported costs are based on Medicare reimbursements, which are lower than private insurance rates,” they wrote

Paolo Goffredo, MD, of the Duke Clinical Research Institute, Durham, North Carolina, and colleagues assessed patterns of inappropriate radioactive iodine therapy in the United States to determine potential misuses that would increase health care system costs and expose patients to risk and possible complications.

The investigators used data from the National Cancer Database (1998-2011) to identify patients diagnosed with anaplastic, medullary and papillary thyroid cancer, cross-validating the population with the Surveillance, Epidemiology and End Results Database.

All adults with anaplastic and medullary thyroid cancers were included, along with patients with papillary thyroid cancer who had microcarcinoma of 1 cm or less, negative margin status and no aggressive histologic variants, extrathyroidal extension, or regional or distant metastases.

Cost estimates were collected from Medicare reimbursement schedules (2011 and 2014) and the U.S. Bureau of Labor Statistics, and only for papillary thyroid microcarcinoma.

Radioactive iodine therapy was inappropriately given to 49 of 3,095 patients with anaplastic cancer (1.6%), 217 of 6,375 patients with medullary cancer (3.4%) and 14,146 of 60,586 patients with papillary thyroid microcarcinoma (23.3%).

Patients with anaplastic cancer who received the therapy were younger (P < .001), had lower income (P = .01), came from a rural or urban rather than metropolitan county (P = .04) and had smaller tumors (P = .001) vs. those who did not receive the therapy.

Patients with medullary cancer given the therapy were less likely to be treated in academic facilities (P < .001) and had smaller tumors (P = .02).

Patients with papillary thyroid microcarcinoma treated with radioactive iodine were younger, more often white, treated in nonacademic centers and more likely to have multifocal and larger tumors (P < .001 for all). Although overall incidence of this type of cancer increased over time, the proportion of patients treated with radioactive iodine decreased; treatment rate did not change in community hospital programs but dropped in comprehensive and academic hospital programs.

Inappropriate radioactive iodine therapy was associated with Hispanic origin, low income, treatment in nonacademic facilities, and tumor multifocality and growth, based on adjusted analyses. Older age, black or other race, more recent year of diagnosis, no insurance or government insurance and undergoing less than a total thyroidectomy were protective factors.

The average cost per patient ranged from $5,588 to $8,442 in 2011 and from $5,430 to $9,106 in 2014. The number of patients per year averaged 1,768, with a total cost of $9,879,109 to $14,925,650 in 2011 and $9,599,497 to $16,098,824 in 2014.

“Ongoing efforts should be undertaken to educate health care professionals in the appropriate use of radioactive iodine therapy to optimize patient care,” the researchers wrote. – by Allegra Tiver

Disclosure: The researchers report no relevant financial disclosures.