Cost-effectiveness-analysis: Radioiodine or antithyroid drugs as first-line therapy of hyperthyroidism due to Graves' disease

Aim: As first-line therapy of hyperthyroidism caused by Graves' disease ant ithyroid drugs are favoured in Europe, while radioiodine therapy is favoure d in the USA. Radioiodine therapy has become more economic in Germany since the new recommendations by the Federal German Radiation Protection Committ ee (SSK) for patient discharge guidelines. Method: Sensitivity analyses too k into account the long-term relapse rate of conservative or radioiodine th erapy, use of diagnostic tests, level of health insurance, drops in product ivity and a discount factor. Costing models included the costs of follow-up care over 30 years. The costs of the hospitalisation for radioiodine thera py were calculated for 300 patients, discharged with 250 MBq I-131 residual activity. Result: Antithyroid drugs were considered cost-effective when th ey achieved relapse Fate of 50% or less, a cut in the number of tests neede d and reduced working hours. Failure to meet any one of these conditions ma kes primary radioiodine therapy more cost-effective in 1593 of 1944 calcula ted costing models. Repeated conservative therapies will increase clearly t he overall costs. Conclusion: Radioiodine is a cost-effective. first-line t herapy in patients with a special risk of relapse after primary conservativ e therapy (goitre, younger patient, persistent elevated TSH-receptor-antibo dies or Tc-uptake).