370 chapter 6 Table 2. Transition probabilities for the Markov Model, including uncertainty Base-case value Source Uncertaintya Discount rates Yearly discount rates for costs 0.040 [29, 477] Fixed Yearly discount rates for utilities 0.015 [29, 477] Fixed Follow-up of [18F]FDG-negative nodules Yearly probability that active surveillance of [18F]FDG-negative nodule ends 0.33 (based on mean 3-year f/u) [528-531], expert opinion 0.2-1.0 Yearly probability to re-enter active surveillance for [18F]FDG-negative nodule 0.01 Expert opinion -50% to +100% Yearly probability of surgery for benign lesion after continued surveillance for [18F]FDG-negative nodule 0.02 [501, 530-532], EfFECTS, expert opinion -50% to +100% Probability of (surgery for) a missed malignancy after initial surveillance for [18F]FDG-negative nodule 0.049 (1-NPV) [38, 486, 501], EfFECTS 0.0-0.1 Maximum timespan for missed malignancy to be detected 5 years Expert opinion 2-15 years Fraction HT of all surgery 0.95 [29], expert opinion 0.90-0.98 Fraction of cTT following HT if malignant 0.607 EfFECTS 0.5-0.7 Recurrence of malignancy Yearly probability of recurrent disease following HT Year 1-5: 0.015 Year 6-10: 0.010 Year 11 onwards: 0.005 [533-541] 0.0075-0.03 0.005-0.02 0.0025-0.01 Probability of (c)TT following recurrence after HT for malignancy 0.917 [29] SD=0.013 Yearly probability of recurrent or persistent malignant disease following (c)TT Year 1-2: 0.070 Year 3-5: 0.040 Year 6-10: 0.010 Year 11 onwards: 0.005 [17, 29, 533, 537-548], EfFECTS -50% to +100% Mortality Yearly probability of death of any cause (not thyroid cancer related) Life tables [527] Fixed Yearly probability of death due to thyroid cancer Year 1-10: 0.005 Year 11-20: 0.003 Year 21 onwards: 0.002 [29, 504, 536-538, 540542, 544, 549, 550] -50% to +100% Perioperative mortality HT/(c)TT 0.0011 [29, 466, 551] -50% to +100% Complications of thyroid surgery Transient complication due to HT 0.0977 [29, 466, 495, 496, 501, 551-557] -50% to +100% Permanent complication due to HT (excluding hypothyroidism) 0.0056 [29, 466, 495, 496, 501, 551, 552, 556, 557] -50% to +100% Medication-dependent hypothyroidism due to HT 0.22 [178, 495, 496, 501, 558, 559] SD=0.020 Transient complication due to (c)TT 0.185 [29, 466, 495, 551-557, 560, 561], EfFECTS -50% to +100% Permanent complication due to (c)TT 0.046 [29, 466, 495, 551, 552, 556, 557, 560], EfFECTS -50% to +100% a: Ranges are for triangular parameter distributions (with mode equal to the base-case value), except when the parameter is fixed or has a normal distribution (as indicated by the SD). DTC, differentiated thyroid carcinoma. EfFECTS, observed data from the first year of the EfFECTS trial were included as a source. HT, hemithyroidectomy. (c)TT, (completing) total thyroidectomy. NPV, negative predictive value. SD, standard deviation.
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