Patient preferences in papillary thyroid microcarcinoma management are driven by aversion toward complications rather than treatment pathway

BACKGROUND: Papillary thyroid microcarcinomas carry an excellent prognosis, making patient preferences and cost-effectiveness important determinants of treatment selection. To conduct cost-effectiveness analyses, quality-adjusted life year weights for papillary thyroid microcarcinoma treatments must be derived. Our objective was to estimate the quality-adjusted life year weights of common papillary thyroid microcarcinoma treatment scenarios. METHODS: This study used 10 previously published papillary thyroid microcarcinoma clinical vignettes describing active surveillance, radiofrequency ablation, partial thyroidectomy, and total thyroidectomy, along with potential complications (progression, vocal cord palsy, hypocalcemia). Quality-adjusted life year weights were derived using a time trade-off instrument administered to thyroid cancer survivors. Quality-adjusted life year weights were compared using within-subjects repeated measures analysis of variance and paired Wilcoxon rank-sum tests. The cohort was powered to detect a minimal important difference with an effect size of 0.5 (ie, 0.04 quality-adjusted life year). RESULTS: Data from 101 thyroid cancer survivors were collected. Median quality-adjusted life year weights for uncomplicated treatment scenarios ranged from 0.975 to 0.992 and were not significantly different between treatments (P = .15). Treatment complications resulted in significantly lower quality-adjusted life year weights across all treatment strategies (P < .01) except active surveillance (P = .72). CONCLUSION: Quality-adjusted life year weights were comparable between the uncomplicated versions all 4 treatment pathways, suggesting that patient treatment preferences for papillary thyroid microcarcinoma are driven by aversion to treatment complications, rather than an inclination toward the experience of the treatments themselves. These quality-adjusted life year weights may be readily incorporated into value assessments for papillary thyroid microcarcinoma treatments.