The thyroid ablation rate with recombinant human thyroid stimulating hormone injections, or rhTSH, was shown in the randomized phase III Etude Stimulation Ablation trial to be similar to that with thyroid hormone withdrawal when used with either 1.1 or 3.7 GBq iodine-131 in patients with thyroid cancer, but a new analysis of data from the trial shows that the use of rhTSH would not be cost effective.
While rhTSH was associated with stable health-related quality of life and was more effective than thyroid hormone withdrawal (THW) with respect to quality-adjusted life-years (mean increase of 0.013 vs. THW), it is far more expensive, and a cost-effectiveness analysis showed that at a willingness-to-pay threshold of $53,300 per QALY, the probability that rhTSH would be cost effective was 47% when direct costs were considered. This increased to 70% when the cost of rhTSH was lowered by 30%, Isabelle Borget, Pharm.D., Ph.D., of Gustave Roussy, Villejuif, France, and her colleagues reported online in the Journal of Clinical Oncology.
Using 1.1 rather than 3.7 GBq of iodine-131 decreased efficacy slightly (mean decrease of 0.007 QALY), but also reduced costs by $1,018, and the probability of cost-effectiveness at the lower iodine-131 level was 65%, the investigators said (J Clin Oncol. 2015 Aug 3. doi: 10.1200/JCO.2015.61.6722).
Although rhTSH was not associated with the transient deterioration in health-related quality of life seen with thyroid hormone withdrawal in the first few months of treatment, it was cost effective only when the price was reduced by 30%; lower iodine-131 activity also reduced overall costs, they concluded.
Dr. Borget reported receiving honoraria from Roche and Janssen-Cilag, and travel, accommodations, and expenses from Janssen-Cilag. Several coauthors reported relationships with Genzyme, Sanofi, Novartis, and/or GE Healthcare, including receiving research support, honoraria, travel/accommodations/expenses, and/or serving as a consultant or advisor.