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Up to 25% of patients with papillary thyroid cancer may receive inappropriate radioactive iodine therapy
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Nearly one-quarter of patients with papillary thyroid cancer may receive unnecessary radioactive iodine treatment, according to study results.
Researchers estimated the annual cost per patient — calculated in 2014 dollars — to be between $5,429 and $9,105, and the total costs ranged from $9.5 million to more than $16 million. However, the investigators emphasized that may be 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,” Paolo Goffredo, MD, research fellow at the Duke Clinical Research Institute, and colleagues wrote.
Goffredo and colleagues assessed patterns of inappropriate radioactive iodine therapy in the United States between 1998 and 2011 to determine potential misuses that increase health care system costs, as well as expose patients to risk and possible complications.
The investigators used data from the National Cancer Data Base to identify patients diagnosed with anaplastic, medullary and papillary thyroid cancer. They used the SEER database to cross-validate the population.
All adults with anaplastic and medullary thyroid cancers were included. 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 also were included.
Researchers used Medicare reimbursement schedules (2011 and 2014) and the U.S. Bureau of Labor Statistics to collect cost estimates for patients with papillary thyroid microcarcinoma.
Goffredo and colleagues determined 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 more likely to be younger (P < .001), have lower income (P = .01), live in a rural or urban county rather than metropolitan county (P = .04), and have smaller tumors (P = .001).
Patients with medullary cancer who received the therapy were less likely to be treated in academic facilities (P < .001) and have smaller tumors (P = .02).
Patients with papillary thyroid microcarcinoma treated with radioactive iodine were more likely to be younger, white, seek treatment in nonacademic centers, and have multifocal and larger tumors (P < .001 for all).
Although overall incidence of papillary thyroid microcarcinoma increased over time, the proportion of patients treated with radioactive iodine decreased. However, the rate with which radioactive iodine was administered only declined in comprehensive and academic hospital programs. Researchers observed no change in community hospital programs.
“This emphasizes the need to educate health care professionals regarding evidence-based practice guidelines and disseminate those guidelines in areas that may serve vulnerable populations,” Goffredo and colleagues wrote.
Adjusted analyses revealed inappropriate radioactive iodine therapy was associated with Hispanic origin, low income, treatment in nonacademic facilities, and tumor multifocality and growth. Older age, black or other race, more recent year of diagnosis, lack of insurance or government insurance, and receipt of less than a total thyroidectomy were protective factors.
“Ongoing efforts should be undertaken to educate health care professionals in the appropriate use of radioactive iodine therapy to optimize patient care,” Goffredo and colleagues concluded. – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.
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