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Nuklearmedizin 2010; 49(06): 216-224
DOI: 10.3413/nukmed-0321-1005
Original article
Schattauer GmbH

Recombinant human TSH versus hypo thyroidism

Cost-minimization-analysis in the follow-up care of differentiated thyroid carcinomaRekombinantes humanes TSH im Vergleich zur Hypo thyreoseKostenanalyse in der Nachsorge des differenzierten Schilddrüsenkarzinoms
M. Dietlein
1   Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Germany
,
S. Busemeyer
1   Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Germany
,
C. Kobe
1   Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Germany
,
M. Schmidt
1   Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Germany
,
P. Theissen
1   Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Germany
,
H. Schicha
1   Klinik und Poliklinik für Nuklearmedizin des Universitätsklinikums Köln, Germany
› Author Affiliations
Further Information

Publication History

received: 28 May 2010

accepted in revised form: 13 September 2010

Publication Date:
24 January 2018 (online)

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Summary

The primary aim of this study was to compare pharmacoeconomic effects of hypothyroidism secondary to hormone withdrawal (THW) and recombinant human TSH (rhTSH) for followup WBS in patients with differentiated thyroid cancer (DTC). The second aim was to determine patients' preference for one procedure or the other. Patients, methods: This retrospective survey included 327 patients with DTC who underwent at least one in-hospital WBS with rhTSH between 1999 and 2006. They had also undergone THW for WBS. Patients received a two-page questionnaire via mail addressing five symptoms and ten items regarding managing their daily life which was answered by 61.6%. The responder group did not differ from the entire group. The medical and societal cost of both procedures for diagnostic WBS was calculated including direct and all ascertainable indirect cost for the reference year 2005. A sensitivity analysis included the German DRG system of 2007 and 2010. Results: After THW, 94% of patients reported hypothyroid symptoms. Using rhTSH, symptoms occurred significantly less. As a result, 97% of patients favored rhTSH over THW. Mean absence from salaried work was 12.3 days after THW compared to 4 days with rhTSH. Family members of salaried employees missed 3 and 0.7 workdays after THW and rhTSH, respectively. Almost twice as often, medical attention was sought after THW (36%) compared to rhTSH (19 %). Undergoing THW, 48% of patients still used their car while hypothyroid. Our cost calculation revealed a slight benefit of about 89.00 Euro in favour of rhTSH stimulation. Conclusion: Hypothyroidism after THW causes significant morbidity and safety risks. The clinical and societal benefits associated with rhTSH are roughly gained at equivalent overall cost to that of THW.

Zusammenfassung

Diese Studie hatte zum Ziel, bei Patienten mit differenziertem Schilddrüsenkarzinom (DTC) die pharmakoökonomischen Aspekte der diagnostischen 131I-Ganzkörperszintigraphie (WBS) unter Hypothyreose im Vergleich zur Euthyreose mit rhTSH-Stimulation zu untersuchen. Ein weiteres Ziel der Studie war, die Präferenz der Patienten für eine der beiden Vorgehensweisen zu ermitteln. Patienten, Methoden: Diese retrospektive Untersuchung berücksichtigt 327 Patienten mit DTC, bei denen zumindest eine 131I WBS nach rhTSH-Stimulation zwischen 1999 und 2006 durchgeführt wurde. Die Patienten hatten sich auch einer WBS in Hypothyreose unterzogen. Sie erhielten per Post einen zweiseitigen Fragebogen, der fünf Hypothyreosesymptome und zehn Fragen zur Bewältigung des täglichen Lebens umfasste. Etwa zwei Drittel (61,6%) beantworteten den Fragebogen. Diese Gruppe wies keine Unterschiede zur Gesamtgruppe auf. Die medizinischen und gesellschaftlichen Kosten beider Verfahren zur Vorbereitung auf die diagnostische WBS wurden unter Hinzuziehung der direkten und aller erfassbaren indirekten Kosten für das Referenzjahr 2005 berechnet. Außerdem erfolgte eine Sensitivitätsanalyse, die auch das deutsche DRG-System von 2007 und 2010 einschloss. Ergebnisse: Unter Schilddrüsenhormonentzug nannten 94% der Patienten Hypothyreosesymptome. Nach rhTSH-Stimulation traten diese Symptome signifikant seltener auf mit dem Ergebnis, dass 97% der Patienten rhTSH gegenüber dem Hormonentzug präferierten. Die mittlere Fehlzeit erwerbstätiger Patienten betrug 12,3 Tage nach THW im Vergleich zu 4 Tagen mit rhTSH. Familienmitglieder von Erwerbstätigen mit THW versäumten 3 Arbeitstage und nach rhTSHStimulation 0,7 Arbeitstage. Zusätzliche Arztbesuche waren nach Hormonentzug etwa doppelt so häufig (36%) im Vergleich zur rhTSH-Stimulation (19%). Während des Hormonentzugs benutzten 48% der Patienten ihr Fahrzeug trotz bestehender Hypothyreose. Die pharmakoökonomische Berechnung ergab einen leichten Kostenvorteil von ca. 89,00 Euro für die rhTSH-Stimulation. Schlussfolgerung: Die Hypothyreose nach Hormonentzug führt zu einer erhöhten Morbidität und zusätzlichen Sicherheitsrisiken. Der klinische und gesellschaftliche Nutzen durch den Einsatz von rhTSH wird mit Gesamtkosten erreicht, die in etwa denen des Hormonentzugs entsprechen.

Keywords

Thyroid cancer - rhTSH - hypothyroidism - 131I whole body scan

Schlüsselwörter

Schilddrüsenkarzinom - rhTSH - Hypothyreose - 131I Ganzkörperszintigraphie
 

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