Using recombinant human thyroid‐stimulating hormone for the diagnosis of recurrent thyroid cancer

Background: Recombinant human thyroid‐stimulating hormone (rhTSH) has been suggested as a diagnostic agent in the diagnosis of recurrent thyroid cancer, instead of the current practice of thyroid hormone (THT) withdrawal. Methods: An evidenced‐based literature review was used as the basis for a cost‐utility, decision‐analytic model. Outcome measures were safety, efficacy (diagnostic performance and quality of life) and cost effectiveness of rhTSH. Results: The literature search identified six comparative studies of rhTSH versus THT withdrawal. The most common adverse events associated with the use of rhTSH were headache (3.5−11.1%) and nausea (7.7−17%). When used as a diagnostic agent, the unadjusted sensitivity and specificity for rhTSH were 87% and 95%, respectively. Thus the use of rhTSH instead of THT withdrawal would result in a reduction in diagnostic accuracy, with 11% of patients’ disease status being misclassified. Use of rhTSH resulted in a higher quality of life in the period prior to diagnostic testing than THT withdrawal ( P < 0.001). When the impact of diagnostic performance, patient compliance to follow‐up and modified quality of life were modelled over a 5 year time‐frame, the incremental cost per QALY of rhTSH relative to THT withdrawal was $51 344.42. Conclusions: The use of rhTSH as a diagnostic agent appears to be safe but less diagnostically accurate and less cost‐effective (on whole of healthcare cost basis) when used in the follow‐up of patients with thyroid cancer who have had a previous negative radioiodine scan after thyroid hormone withdrawal.