Prophylactic Central Neck Dissection Increases the Cost of Thyroid Cancer Care
Over the past several decades, health care spending has risen faster than any other segment of the United States economy and continues to rise.1 Media attention has been focused on health care costs since the introduction of the Patient Protection and Affordable Care Act of 2010, which aims to reduce costs of health care while improving outcomes. Physicians are in the best position to determine which treatments are effective and which patients benefit most, and they are more cognizant than ever of the mandate to spend our limited health care dollars wisely. Cost minimization should be the goal of every physician, as long as quality of care does not diminish.
The incidence of papillary thyroid cancer (PTC) is increasing in the United States, but thankfully survival is excellent compared with many other cancers. Patients diagnosed when the disease is limited to the thyroid gland are nearly always cured with thyroidectomy. Unfortunately, regional lymph node metastases from PTC are very com
- Emanuel E, Tanden N, Altman S, Armstrong S, Berwick D, de Brantes F, et al. A systemic approach to containing health care spending. New Engl J Med. 2012;367:949–54. CrossRef
- Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty GM, Kim LT, et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44. CrossRef
- Lang BH, Wong CK. A cost-minimization analysis comparing total thyroidectomy alone and total thyroidectomy with prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma. Ann Surg Oncol. 2013. doi:10.1245/s10434-013-3234-9.
- Lang BH, Ng SH, Lau LL, Cowling BJ, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 2013;23:1087–98. CrossRef
- Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol. 2012;19:4217–22. CrossRef
- Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. 2009;19:1167–214.
- Prophylactic Central Neck Dissection Increases the Cost of Thyroid Cancer Care
Annals of Surgical Oncology
Volume 21, Issue 2 , pp 354-355
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