Publications
2024
Wongseree, Peeradon; Hasgul, Zeynep; Jalali, Mohammad S.
Cost-Effectiveness of Increasing Access to Colorectal Cancer Diagnosis: Analysis From Thailand Journal Article
In: Value in Health Regional Issues, vol. 43, 2024.
Abstract | Links | BibTeX | Tags: Cancer, Simulation modeling
@article{nokey,
title = {Cost-Effectiveness of Increasing Access to Colorectal Cancer Diagnosis: Analysis From Thailand},
author = {Peeradon Wongseree and Zeynep Hasgul and Mohammad S. Jalali},
url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2024/06/Wongseree_VIH_RI.pdf},
year = {2024},
date = {2024-06-01},
urldate = {2024-06-01},
journal = {Value in Health Regional Issues},
volume = {43},
abstract = {Objectives
The purpose of this study is to evaluate the cost-effectiveness of increasing access to colorectal cancer (CRC) diagnosis, considering resource limitations in Thailand.
Methods
We analyzed the cost-effectiveness of increasing access to fecal immunochemical test screening (strategy I), symptom evaluation (strategy II), and their combination through healthcare and societal perspectives using Colo-Sim, a simulation model of CRC care. We extended our analysis by adding a risk-stratification score (RS) to the strategies. We analyzed all strategies under the currently limited annual colonoscopy capacity and sufficient capacity. We estimated quality-adjusted life-years (QALYs) and costs over 2023 to 2047 and performed sensitivity analyses.
Results
Annual costs for CRC care will increase over 25 years in Thailand, resulting in a cumulative cost of 323B Thai baht (THB). Each strategy results in higher QALYs gained and additional costs. With the current colonoscopy capacity and willingness-to-pay threshold of 160 000 THB, strategy I with and without RS is not cost-effective. Strategy II + RS is the most cost-effective, resulting in 0.68 million QALYs gained with additional costs of 66B THB. Under sufficient colonoscopy capacity, all strategies are deemed cost-effective, with the combined approach (strategy I + II + RS) being the most favorable, achieving the highest QALYs (1.55 million) at an additional cost of 131 billion THB. This strategy also maintains the highest probability of being cost-effective at any willingness-to-pay threshold above 96 000 THB.
Conclusions
In Thailand, fecal immunochemical test screening, symptom evaluation, and RS use can achieve the highest QALYs; however, boosting colonoscopy capacity is essential for cost-effectiveness.},
keywords = {Cancer, Simulation modeling},
pubstate = {published},
tppubtype = {article}
}
Objectives
The purpose of this study is to evaluate the cost-effectiveness of increasing access to colorectal cancer (CRC) diagnosis, considering resource limitations in Thailand.
Methods
We analyzed the cost-effectiveness of increasing access to fecal immunochemical test screening (strategy I), symptom evaluation (strategy II), and their combination through healthcare and societal perspectives using Colo-Sim, a simulation model of CRC care. We extended our analysis by adding a risk-stratification score (RS) to the strategies. We analyzed all strategies under the currently limited annual colonoscopy capacity and sufficient capacity. We estimated quality-adjusted life-years (QALYs) and costs over 2023 to 2047 and performed sensitivity analyses.
Results
Annual costs for CRC care will increase over 25 years in Thailand, resulting in a cumulative cost of 323B Thai baht (THB). Each strategy results in higher QALYs gained and additional costs. With the current colonoscopy capacity and willingness-to-pay threshold of 160 000 THB, strategy I with and without RS is not cost-effective. Strategy II + RS is the most cost-effective, resulting in 0.68 million QALYs gained with additional costs of 66B THB. Under sufficient colonoscopy capacity, all strategies are deemed cost-effective, with the combined approach (strategy I + II + RS) being the most favorable, achieving the highest QALYs (1.55 million) at an additional cost of 131 billion THB. This strategy also maintains the highest probability of being cost-effective at any willingness-to-pay threshold above 96 000 THB.
Conclusions
In Thailand, fecal immunochemical test screening, symptom evaluation, and RS use can achieve the highest QALYs; however, boosting colonoscopy capacity is essential for cost-effectiveness.
The purpose of this study is to evaluate the cost-effectiveness of increasing access to colorectal cancer (CRC) diagnosis, considering resource limitations in Thailand.
Methods
We analyzed the cost-effectiveness of increasing access to fecal immunochemical test screening (strategy I), symptom evaluation (strategy II), and their combination through healthcare and societal perspectives using Colo-Sim, a simulation model of CRC care. We extended our analysis by adding a risk-stratification score (RS) to the strategies. We analyzed all strategies under the currently limited annual colonoscopy capacity and sufficient capacity. We estimated quality-adjusted life-years (QALYs) and costs over 2023 to 2047 and performed sensitivity analyses.
Results
Annual costs for CRC care will increase over 25 years in Thailand, resulting in a cumulative cost of 323B Thai baht (THB). Each strategy results in higher QALYs gained and additional costs. With the current colonoscopy capacity and willingness-to-pay threshold of 160 000 THB, strategy I with and without RS is not cost-effective. Strategy II + RS is the most cost-effective, resulting in 0.68 million QALYs gained with additional costs of 66B THB. Under sufficient colonoscopy capacity, all strategies are deemed cost-effective, with the combined approach (strategy I + II + RS) being the most favorable, achieving the highest QALYs (1.55 million) at an additional cost of 131 billion THB. This strategy also maintains the highest probability of being cost-effective at any willingness-to-pay threshold above 96 000 THB.
Conclusions
In Thailand, fecal immunochemical test screening, symptom evaluation, and RS use can achieve the highest QALYs; however, boosting colonoscopy capacity is essential for cost-effectiveness.
2023
Wongseree, Peeradon; Hasgul, Zeynep; Leerapan, Borwornsom; Iramaneerat, Cherdsak; Phisalprapa, Pochamana; Jalali, Mohammad S.
Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand Journal Article
In: Preventive Medicine, iss. 175, pp. 107694, 2023.
Abstract | Links | BibTeX | Tags: Cancer, Simulation modeling
@article{nokey,
title = {Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand},
author = {Peeradon Wongseree and Zeynep Hasgul and Borwornsom Leerapan and Cherdsak Iramaneerat and Pochamana Phisalprapa and Mohammad S. Jalali},
url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2023/09/ColoSIM_2023.pdf
https://mj-lab.mgh.harvard.edu/colo-sim-model},
year = {2023},
date = {2023-09-01},
urldate = {2023-09-01},
journal = {Preventive Medicine},
issue = {175},
pages = {107694},
abstract = {Background
Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand.
Methods
We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination.
Results
Projecting the status quo (2023−2032), deaths per 100K people increase from 87.5 to 115.4, and CRC progressions per 100K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100K people, with cumulative prevented 7K deaths and 9K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100K with no effect on progression, totaling 35K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100K, or 41K and 7K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100K people, or 54K and 30K cumulatively.
Conclusion
Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.},
keywords = {Cancer, Simulation modeling},
pubstate = {published},
tppubtype = {article}
}
Background
Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand.
Methods
We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination.
Results
Projecting the status quo (2023−2032), deaths per 100K people increase from 87.5 to 115.4, and CRC progressions per 100K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100K people, with cumulative prevented 7K deaths and 9K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100K with no effect on progression, totaling 35K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100K, or 41K and 7K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100K people, or 54K and 30K cumulatively.
Conclusion
Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.
Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand.
Methods
We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination.
Results
Projecting the status quo (2023−2032), deaths per 100K people increase from 87.5 to 115.4, and CRC progressions per 100K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100K people, with cumulative prevented 7K deaths and 9K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100K with no effect on progression, totaling 35K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100K, or 41K and 7K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100K people, or 54K and 30K cumulatively.
Conclusion
Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.
Vinke, Petra C.; Combalia, Marc; de Bock, Geertruida H; Leyrat, Clémence; Spanjaart, Anne Mea; Dalle, Stephane; da Silva, Maria Gomes; Essongue, Aurore Fouda; Rabier, Aurélie; Pannard, Myriam; Jalali, Mohammad S.; Elgammal, Amal; Papazoglou, Mike; Hacid, Mohand-Said; Rioufol, Catherine; Kersten, Marie-José; van Oijen, Martijn GH; Suazo-Zepeda, Erick; Malhotra, Ananya; Coquery, Emmanuel; Anota, Amélie; Preau, Marie; Fauvernier, Mathieu; Coz, Elsa; Puig, Susana; Maucort-Boulch, Delphine
In: BMJ Open, vol. 13, pp. e069090, 2023.
Abstract | Links | BibTeX | Tags: Cancer
@article{nokey,
title = {Monitoring multidimensional aspects of quality of life after cancer immunotherapy: protocol for the international multicentre, observational QUALITOP cohort study},
author = {Petra C. Vinke and Marc Combalia and Geertruida H de Bock and Clémence Leyrat and Anne Mea Spanjaart and Stephane Dalle and Maria Gomes da Silva and Aurore Fouda Essongue and Aurélie Rabier and Myriam Pannard and Mohammad S. Jalali and Amal Elgammal and Mike Papazoglou and Mohand-Said Hacid and Catherine Rioufol and Marie-José Kersten and Martijn GH van Oijen and Erick Suazo-Zepeda and Ananya Malhotra and Emmanuel Coquery and Amélie Anota and Marie Preau and Mathieu Fauvernier and Elsa Coz and Susana Puig and Delphine Maucort-Boulch},
url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2023/04/e069090.full_.pdf},
year = {2023},
date = {2023-04-28},
urldate = {2023-04-28},
journal = {BMJ Open},
volume = {13},
pages = {e069090},
abstract = {Introduction Immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, have significantly improved the clinical outcomes of various malignancies. However, they also cause immune-related adverse events (irAEs) that can be challenging to predict, prevent and treat. Although they likely interact with health-related quality of life (HRQoL), most existing evidence on this topic has come from clinical trials with eligibility criteria that may not accurately reflect real-world settings. The QUALITOP project will study HRQoL in relation to irAEs and its determinants in a real-world study of patients treated with immunotherapy.
Methods and analysis This international, observational, multicentre study takes place in France, the Netherlands, Portugal and Spain. We aim to include about 1800 adult patients with cancer treated with immunotherapy in a specifically recruited prospective cohort, and to additionally obtain data from historical real-world databases (ie, databiobanks) and medical administrative registries (ie, national cancer registries) in which relevant data regarding other adult patients with cancer treated with immunotherapy has already been stored. In the prospective cohort, clinical health status, HRQoL and psychosocial well-being will be monitored until 18 months after treatment initiation through questionnaires (at baseline and 3, 6, 12 and 18 months thereafter), and by data extraction from electronic patient files. Using advanced statistical methods, including causal inference methods, artificial intelligence algorithms and simulation modelling, we will use data from the QUALITOP cohort to improve the understanding of the complex relationships among treatment regimens, patient characteristics, irAEs and HRQoL.
Ethics and dissemination All aspects of the QUALITOP project will be conducted in accordance with the Declaration of Helsinki and with ethical approval from a suitable local ethics committee, and all patients will provide signed informed consent. In addition to standard dissemination efforts in the scientific literature, the data and outcomes will contribute to a smart digital platform and medical data lake. These will (1) help increase knowledge about the impact of immunotherapy, (2) facilitate improved interactions between patients, clinicians and the general population and (3) contribute to personalised medicine.},
keywords = {Cancer},
pubstate = {published},
tppubtype = {article}
}
Introduction Immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, have significantly improved the clinical outcomes of various malignancies. However, they also cause immune-related adverse events (irAEs) that can be challenging to predict, prevent and treat. Although they likely interact with health-related quality of life (HRQoL), most existing evidence on this topic has come from clinical trials with eligibility criteria that may not accurately reflect real-world settings. The QUALITOP project will study HRQoL in relation to irAEs and its determinants in a real-world study of patients treated with immunotherapy.
Methods and analysis This international, observational, multicentre study takes place in France, the Netherlands, Portugal and Spain. We aim to include about 1800 adult patients with cancer treated with immunotherapy in a specifically recruited prospective cohort, and to additionally obtain data from historical real-world databases (ie, databiobanks) and medical administrative registries (ie, national cancer registries) in which relevant data regarding other adult patients with cancer treated with immunotherapy has already been stored. In the prospective cohort, clinical health status, HRQoL and psychosocial well-being will be monitored until 18 months after treatment initiation through questionnaires (at baseline and 3, 6, 12 and 18 months thereafter), and by data extraction from electronic patient files. Using advanced statistical methods, including causal inference methods, artificial intelligence algorithms and simulation modelling, we will use data from the QUALITOP cohort to improve the understanding of the complex relationships among treatment regimens, patient characteristics, irAEs and HRQoL.
Ethics and dissemination All aspects of the QUALITOP project will be conducted in accordance with the Declaration of Helsinki and with ethical approval from a suitable local ethics committee, and all patients will provide signed informed consent. In addition to standard dissemination efforts in the scientific literature, the data and outcomes will contribute to a smart digital platform and medical data lake. These will (1) help increase knowledge about the impact of immunotherapy, (2) facilitate improved interactions between patients, clinicians and the general population and (3) contribute to personalised medicine.
Methods and analysis This international, observational, multicentre study takes place in France, the Netherlands, Portugal and Spain. We aim to include about 1800 adult patients with cancer treated with immunotherapy in a specifically recruited prospective cohort, and to additionally obtain data from historical real-world databases (ie, databiobanks) and medical administrative registries (ie, national cancer registries) in which relevant data regarding other adult patients with cancer treated with immunotherapy has already been stored. In the prospective cohort, clinical health status, HRQoL and psychosocial well-being will be monitored until 18 months after treatment initiation through questionnaires (at baseline and 3, 6, 12 and 18 months thereafter), and by data extraction from electronic patient files. Using advanced statistical methods, including causal inference methods, artificial intelligence algorithms and simulation modelling, we will use data from the QUALITOP cohort to improve the understanding of the complex relationships among treatment regimens, patient characteristics, irAEs and HRQoL.
Ethics and dissemination All aspects of the QUALITOP project will be conducted in accordance with the Declaration of Helsinki and with ethical approval from a suitable local ethics committee, and all patients will provide signed informed consent. In addition to standard dissemination efforts in the scientific literature, the data and outcomes will contribute to a smart digital platform and medical data lake. These will (1) help increase knowledge about the impact of immunotherapy, (2) facilitate improved interactions between patients, clinicians and the general population and (3) contribute to personalised medicine.
2022
Beaulieu, Elizabeth; Spanjaart, Anne; Roes, Ashley; Rachet, Bernard; Dalle, Stéphane; Kersten, Marie José; Maucort-Boulch, Delphine; Jalali, Mohammad S.
Health-Related Quality of Life in Cancer Immunotherapy: A Systematic Perspective, Using Causal Loop Diagrams Journal Article
In: Quality of Life Research, vol. 31, pp. 2357-2366, 2022.
Abstract | Links | BibTeX | Tags: Cancer, Participatory modeling
@article{Beaulieu2022,
title = {Health-Related Quality of Life in Cancer Immunotherapy: A Systematic Perspective, Using Causal Loop Diagrams},
author = {Elizabeth Beaulieu and Anne Spanjaart and Ashley Roes and Bernard Rachet and Stéphane Dalle and Marie José Kersten and Delphine Maucort-Boulch and Mohammad S. Jalali},
doi = {10.1007/s11136-022-03110-5},
year = {2022},
date = {2022-03-19},
urldate = {2022-03-19},
journal = {Quality of Life Research},
volume = {31},
pages = {2357-2366},
abstract = {Purpose: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the HRQoL of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for quality of life (HRQoL) of cancer immunotherapy patients. Methods: We first apply a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively review and enhance the CLD through interviews with subject-matter experts. Results: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL. Conclusion: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains. },
keywords = {Cancer, Participatory modeling},
pubstate = {published},
tppubtype = {article}
}
Purpose: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the HRQoL of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for quality of life (HRQoL) of cancer immunotherapy patients. Methods: We first apply a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively review and enhance the CLD through interviews with subject-matter experts. Results: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL. Conclusion: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains.
DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S.; Toumi, Asmae; Watson, Tina; Gazelle, G Scott; Mercaldo, Nathaniel; Lubitz, Carrie C
In: Thyroid, vol. 32, no. 10, 2022.
@article{DiGennaro2022,
title = {Assessing Bias and Limitations of Clinical Validation Studies of Molecular Diagnostic Tests for Indeterminate Thyroid Nodules: Systematic Review and Meta-Analysis},
author = {Catherine DiGennaro and Vahab Vahdat and Mohammad S. Jalali and Asmae Toumi and Tina Watson and G Scott Gazelle and Nathaniel Mercaldo and Carrie C Lubitz},
url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Digennaro_2022_Thyroid.pdf},
doi = {10.1089/thy.2022.0269},
year = {2022},
date = {2022-03-18},
urldate = {2022-03-18},
journal = {Thyroid},
volume = {32},
number = {10},
keywords = {Cancer},
pubstate = {published},
tppubtype = {article}
}
2020
Toumi, Asmae; DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S.; Gazelle, Scott G; Chhatwal, Jagpreet; Kelz, Rachel R; Lubitz, Carrie C
Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018 Journal Article
In: Thyroid, 2020.
Abstract | Links | BibTeX | Tags: Cancer
@article{667452,
title = {Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018},
author = {Asmae Toumi and Catherine DiGennaro and Vahab Vahdat and Mohammad S. Jalali and Scott G Gazelle and Jagpreet Chhatwal and Rachel R Kelz and Carrie C Lubitz},
url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2024/12/Toumi_thyroid_2021.pdf},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {Thyroid},
abstract = {Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBMtextregistered MarketScantextregistered Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.},
keywords = {Cancer},
pubstate = {published},
tppubtype = {article}
}
Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBMtextregistered MarketScantextregistered Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.