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The Value Of Veterans Affairs Hospitals In Cardiothoracic Surgical Training
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
a low complication rate and cost. The three commonly-available treatment options for GD are antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy. Thyroidectomy is the least utilized option in the United States, and when performed is usually a near-total thyroidectomy. Subtotal thyroidectomy is rarely used due to concerns over cost, high recurrence rate, and low postoperative euthyroid rate. We hypothesized that, under the proper conditions, subtotal thyroidectomy would be a cost-effective treatment for patients with GD when compared to RAI, ATD, or total thyroidectomy. The specific aims of this study were to characterize the conditions which would favor subtotal thyroidectomy for GD. Methods: Cost-effectiveness analysis was performed using a Markov transition-state model to compare operative versus medical treatment strategies for GD. A decision model was developed based on a standardized reference case of a 30 year old patient with GD. Treatment outcomes and their probabilities were identified based on literature review. Reference case assumptions for the outcomes of subtotal thyroidectomy included a 32% rate of hypothyroidism, 60% euthyroidism, and 8% recurrent GD based on meta analysis data. Costs were estimated using Medicare charge and reimbursement data and the Nationwide Inpatient Sample. Outcomes were weighted using QOL utility factors, yielding quality-adjusted life years (QALYs) as a measure of effectiveness. All future costs and QALYs realized were assigned a 3% discount rate. Univariate and multivariate sensitivity analysis and Monte Carlo simulation were used to examine the uncertainty of costs, probabilities, and utility estimates in the model. Results: The subtotal thyroidectomy strategy produced 25.783 QALYs. The incremental costeffectiveness ratio was $29,847 per QALY gained, reflecting a gain of 0.091 QALYs at an additional cost of $2,710 compared to RAI. The total thyroidectomy strategy yielded fewer QALYs (25.611) than subtotal thyroidectomy or RAI. The ATD strategy was the least effective, producing an expected 25.591 QALYs. Sensitivity analysis demonstrated that subtotal thyroidectomy was cost-effective compared to RAI only if the initial postoperative euthyroid rate was greater than 50%, the recurrence rate was less than 18%, and the total cost of surgery was less than $6,700. Monte Carlo simulation showed the subtotal thyroidectomy strategy to be optimal in 792/1,000 hypothetical GD patients. Conclusions: This study demonstrates that subtotal thyroidectomy can be a cost-effective treatment for GD. However, a thyroidectomy technique with an initial postoperative euthyroid rate greater than 50% and a recurrence rate of less than 18% was necessary.
QUICKSHOT SESSION: THURSDAY, FEB 3, 2011 3:30 - 5:30 PM
Division of Cardiothoracic Surgery, Jackson, MS; 6University of Colorado Denver, Aurora, CO
48.3. The Evaluation of a Novel Computed Tomography Volume Index Score (CTVI) for Pulmonary Contusion to Accurately Predict Outcomes in Patients With Blunt Thoracic Injury. A. Strumwasser, E. Chu, E. Cureton, R. Kwan, K. Dozier, L. Yeung, E. Miraflor, J. Sadjadi, G. Victorino; UCSF-East Bay Department of Surgery, Oakland, CA
48.4. Three-dimensional Computed Tomographic Analysis of Bronchial Arteries for Preoperative Simulation of Esophageal Cancer Surgery. T. Wada,1 T. Oyama,1 R. Nakamura,1 N. Wada,1 M. Jinzaki,2 Y. Saikawa,1 S. Kuribayashi,2 H. Takeuchi,1 T. Takahashi,1 Y. Kitagawa1; 1 Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo; 2Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo
48.5. Predictors Of In-hospital Complications After Pericardiectomy: A Nationwide Outcomes Study. R. R. Gopaldas,1 A. K. Tharakan,1 T. K. Dao,2 J. G. Markley,1 N. R. Caron1; 1University of Missouri-Columbia School of Medicine, Columbia, MO; 2University of Houston, Houston, TX
48.6. Timely Tracheobronchial Stenting Provides Significant Cost-Savings In Malignant Central Airway Obstruction. K. Park, S. S. Razi, G. Schwartz, S. Belsley, G. Todd, C. P. Connery, F. Y. Bhora; St. Luke’s - Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY
48.7. Predictors Of Limited Resection For Early Stage NonSmall Cell Lung Cancer. S. E. Billmeier,1 J. Z. Ayanian,1,3 A. M. Zaslavsky,3 D. R. Nerenz,2 M. T. Jaklitsch,1 S. O. Rogers1; 1Brigham and Women’s Hospital, Boston, MA; 2 Center for Health Services Research, Henry Ford Health System, Detroid, MI; 3Harvard Medical School Department of Health Care Policy, Boston, MA
48.1. Transition From Open Pulmonary Lobectomy To Thoracoscopic Lobectomy As The Standard Of Care For Early Stage Lung Cancer Does Not Detrimentally Affect Resident Operative Experience. D. T. Cooke, A. P. Mahfoozi, V. Kuderer, J. Young, R. F. Calhoun; University of California, Davis Medical Center, Division of Cardiothoracic Surgery, Sacramento, CA
48.8. Pemetrexed (Alimta) Cytotoxicity In An In Vitro Chemoresponse Assay For Non-Small Cell Lung Carcinoma (NSCLC). M. J. Schuchert,1 R. J. Landreneau,1 R. J. Cerfolio,2 J. D. Luketich,1 R. J. McKenna,3 C. B. Fuller,3 S. L. Suchy,4 S. L. Brower,4 P. R. Ervin4; 1Department of Cardiothoracic Surgery; University of Pittsburgh Medical Center, Pittsburgh, PA; 2Cardiothoracic Surgery; University of Alabama At Birmingham, Birmingham, AL; 3Cedars-Sinai Medical Center, Los Angeles, CA; 4Precision Therapeutics, Inc., Pittsburgh, PA
48.2. The Value Of Veterans Affairs Hospitals In Cardiothoracic Surgical Training. F. G. Bakaeen,1 E. H. Stephens,1 D. Chu,1 J. S. Coselli,1 W. L. Holman,2 A. A. Vaporciyan,3 B. L. Cmolik,4 W. H. Merril,5 F. L. Grover6; 1Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX; 2University of Alabama At Birmingham, Birmingham, AL; 3The University of Texas MD Anderson Cancer Center, Houston, TC; 4Louis Stokes Cleveland VA Medical Center, Cleveland, OH; 5University of Mississippi,
48.9. Cellular Proliferation And Lung Recruitment Of CD133 +/FlK-1+ Cells In The Initial Phase Of Post-Pneumonectomy Compensatory Lung Growth (PPCLG). N. Ghobril,1,2 F. Lim,1,2 S. Lang,1,2 H. N. Jones,1,2 L. D. Le,1,2 S. G. Keswan,1,2 M. Habli,1,2 T. M. Crombleholme1,2; 1The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; 2Division of Pediatric General & Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
CARDIOTHORACIC 2: THORACIC & VASCULAR
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
a low complication rate and cost. The three commonly-available treatment options for GD are antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy. Thyroidectomy is the least utilized option in the United States, and when performed is usually a near-total thyroidectomy. Subtotal thyroidectomy is rarely used due to concerns over cost, high recurrence rate, and low postoperative euthyroid rate. We hypothesized that, under the proper conditions, subtotal thyroidectomy would be a cost-effective treatment for patients with GD when compared to RAI, ATD, or total thyroidectomy. The specific aims of this study were to characterize the conditions which would favor subtotal thyroidectomy for GD. Methods: Cost-effectiveness analysis was performed using a Markov transition-state model to compare operative versus medical treatment strategies for GD. A decision model was developed based on a standardized reference case of a 30 year old patient with GD. Treatment outcomes and their probabilities were identified based on literature review. Reference case assumptions for the outcomes of subtotal thyroidectomy included a 32% rate of hypothyroidism, 60% euthyroidism, and 8% recurrent GD based on meta analysis data. Costs were estimated using Medicare charge and reimbursement data and the Nationwide Inpatient Sample. Outcomes were weighted using QOL utility factors, yielding quality-adjusted life years (QALYs) as a measure of effectiveness. All future costs and QALYs realized were assigned a 3% discount rate. Univariate and multivariate sensitivity analysis and Monte Carlo simulation were used to examine the uncertainty of costs, probabilities, and utility estimates in the model. Results: The subtotal thyroidectomy strategy produced 25.783 QALYs. The incremental costeffectiveness ratio was $29,847 per QALY gained, reflecting a gain of 0.091 QALYs at an additional cost of $2,710 compared to RAI. The total thyroidectomy strategy yielded fewer QALYs (25.611) than subtotal thyroidectomy or RAI. The ATD strategy was the least effective, producing an expected 25.591 QALYs. Sensitivity analysis demonstrated that subtotal thyroidectomy was cost-effective compared to RAI only if the initial postoperative euthyroid rate was greater than 50%, the recurrence rate was less than 18%, and the total cost of surgery was less than $6,700. Monte Carlo simulation showed the subtotal thyroidectomy strategy to be optimal in 792/1,000 hypothetical GD patients. Conclusions: This study demonstrates that subtotal thyroidectomy can be a cost-effective treatment for GD. However, a thyroidectomy technique with an initial postoperative euthyroid rate greater than 50% and a recurrence rate of less than 18% was necessary.
QUICKSHOT SESSION: THURSDAY, FEB 3, 2011 3:30 - 5:30 PM
Division of Cardiothoracic Surgery, Jackson, MS; 6University of Colorado Denver, Aurora, CO
48.3. The Evaluation of a Novel Computed Tomography Volume Index Score (CTVI) for Pulmonary Contusion to Accurately Predict Outcomes in Patients With Blunt Thoracic Injury. A. Strumwasser, E. Chu, E. Cureton, R. Kwan, K. Dozier, L. Yeung, E. Miraflor, J. Sadjadi, G. Victorino; UCSF-East Bay Department of Surgery, Oakland, CA
48.4. Three-dimensional Computed Tomographic Analysis of Bronchial Arteries for Preoperative Simulation of Esophageal Cancer Surgery. T. Wada,1 T. Oyama,1 R. Nakamura,1 N. Wada,1 M. Jinzaki,2 Y. Saikawa,1 S. Kuribayashi,2 H. Takeuchi,1 T. Takahashi,1 Y. Kitagawa1; 1 Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo; 2Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo
48.5. Predictors Of In-hospital Complications After Pericardiectomy: A Nationwide Outcomes Study. R. R. Gopaldas,1 A. K. Tharakan,1 T. K. Dao,2 J. G. Markley,1 N. R. Caron1; 1University of Missouri-Columbia School of Medicine, Columbia, MO; 2University of Houston, Houston, TX
48.6. Timely Tracheobronchial Stenting Provides Significant Cost-Savings In Malignant Central Airway Obstruction. K. Park, S. S. Razi, G. Schwartz, S. Belsley, G. Todd, C. P. Connery, F. Y. Bhora; St. Luke’s - Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY
48.7. Predictors Of Limited Resection For Early Stage NonSmall Cell Lung Cancer. S. E. Billmeier,1 J. Z. Ayanian,1,3 A. M. Zaslavsky,3 D. R. Nerenz,2 M. T. Jaklitsch,1 S. O. Rogers1; 1Brigham and Women’s Hospital, Boston, MA; 2 Center for Health Services Research, Henry Ford Health System, Detroid, MI; 3Harvard Medical School Department of Health Care Policy, Boston, MA
48.1. Transition From Open Pulmonary Lobectomy To Thoracoscopic Lobectomy As The Standard Of Care For Early Stage Lung Cancer Does Not Detrimentally Affect Resident Operative Experience. D. T. Cooke, A. P. Mahfoozi, V. Kuderer, J. Young, R. F. Calhoun; University of California, Davis Medical Center, Division of Cardiothoracic Surgery, Sacramento, CA
48.8. Pemetrexed (Alimta) Cytotoxicity In An In Vitro Chemoresponse Assay For Non-Small Cell Lung Carcinoma (NSCLC). M. J. Schuchert,1 R. J. Landreneau,1 R. J. Cerfolio,2 J. D. Luketich,1 R. J. McKenna,3 C. B. Fuller,3 S. L. Suchy,4 S. L. Brower,4 P. R. Ervin4; 1Department of Cardiothoracic Surgery; University of Pittsburgh Medical Center, Pittsburgh, PA; 2Cardiothoracic Surgery; University of Alabama At Birmingham, Birmingham, AL; 3Cedars-Sinai Medical Center, Los Angeles, CA; 4Precision Therapeutics, Inc., Pittsburgh, PA
48.2. The Value Of Veterans Affairs Hospitals In Cardiothoracic Surgical Training. F. G. Bakaeen,1 E. H. Stephens,1 D. Chu,1 J. S. Coselli,1 W. L. Holman,2 A. A. Vaporciyan,3 B. L. Cmolik,4 W. H. Merril,5 F. L. Grover6; 1Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX; 2University of Alabama At Birmingham, Birmingham, AL; 3The University of Texas MD Anderson Cancer Center, Houston, TC; 4Louis Stokes Cleveland VA Medical Center, Cleveland, OH; 5University of Mississippi,
48.9. Cellular Proliferation And Lung Recruitment Of CD133 +/FlK-1+ Cells In The Initial Phase Of Post-Pneumonectomy Compensatory Lung Growth (PPCLG). N. Ghobril,1,2 F. Lim,1,2 S. Lang,1,2 H. N. Jones,1,2 L. D. Le,1,2 S. G. Keswan,1,2 M. Habli,1,2 T. M. Crombleholme1,2; 1The Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; 2Division of Pediatric General & Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
CARDIOTHORACIC 2: THORACIC & VASCULAR