BRAFV600E testing for low-risk papillary thyroid microcarcinomas --
Computational model from a patient-oriented approach
Abstract
Background: Given the good prognosis of low-risk papillary thyroid
microcarcinomas (lrPTMCs) accurate risk stratification is valuable to
optimize management: active surveillance vs. surgery. BRAFV600E testing
was associated with increased recurrence risk, hence AS seems reasonable
for mutation-negative lrPTMC. However, when considering AS, patient
perception is highly important as adherence and emotional aspects are
challenging. In this study, we aimed to model the contribution of
BRAFV600E testing for the management of PTMCs when tailored to the
patient perspective. Methods: We developed a Markovian model to predict
the role of BRAFV600E in prioritizing between hemithyroidectomy (HT) and
active surveillance (AS) for lrPTMCs. We used a simulated cohort of
lrPTMCs, with probabilities of each strategy driven from previous
literature. Outcomes were measured as quality-of-life years (QALYs).
One- and two-way sensitivity analyses were conducted to ascertain model
robustness. Results: We found that the optimal strategy (e.g., that
would maximize QALYs) varies according to BRAFV600E status for patients
without a preset predilection between AS to HT. Using one-way
sensitivity analysis, we found that the two main variables that have the
strongest impact on the decision are the utility of AS and the utility
of a disease-free state after HT. Two-way sensitivity analysis
demonstrated that BRAFV600E status can define the optimal strategy for
patients in the middle zone of the utility range (e.g., patients without
clear preference). Conclusions: Our model suggests that BRAFV600E status
can facilitate decision-making regarding AS vs. HT for patients without
preset predilection. Our model supports further real-life studies of
BRAFV600E testing for PTMCs.