在本研究中，我们从中国医疗体系的角度比较了微小乳头状甲状腺癌（PTMC）的积极监测（AS）和早期手术（ES）治疗方法的成本效益。我们使用自行开发的PTMC马尔可夫模型进行成本效益分析，评估AS和ES的增量成本效益比率。我们的参考案例是一名40岁的女性，诊断为单发（<10mm）PTMC。通过广泛的文献回顾提取相关数据，并使用中国医保支付ES和AS的数据确定每个阶段的成本。愿意支付阈值设置为每获得一个QALY需支付242,928元。进行了敏感性分析，以考虑模型变量的不确定性。进行了额外的亚组分析，以确定在不同的初始监测年龄下，AS是否具有成本效益。 ES的效果为5.2个QALY，而AS的效果为25.8个QALY。此外，ES与AS的增量成本效益比率为1,009元/QALY。所有敏感性分析的发现都是稳健的。与ES相比，AS在初始监测年龄为20岁和60岁时被发现是成本效益的策略，其增量成本效益比率分别为3,431元/QALY和-1,316元/QALY。对于年龄大于60岁的PTMC患者，AS是一种更具成本效益的策略。从中国医疗体系的标准来看，AS在终身监测中对PTMC具有更好的成本效益，而且，即使初始监测年龄不同，AS也具有成本效益。此外，如果AS在中国针对PTMC的管理计划中尽早纳入，每50,000例PTMC患者可节约1,000,000,000元/年的预计费用，这为未来的管理计划提供了良好的经济回报。这些细微差别的发现可以帮助医生和患者确定最佳和最个体化的低风险PTMC长期管理策略。 版权所有 © 2023 Lai, Zhang, Qin, An, Li和Yuan。

In this study, we compared the cost-effectiveness comparison of the active surveillance (AS) and early surgery (ES) approaches for papillary thyroid microcarcinoma (PTMC) from the perspective of the Chinese healthcare system.We performed a cost-effectiveness analysis using a Markov model of PTMC we developed to evaluate the incremental cost-effectiveness ratio of AS and ES. Our reference case was of a 40-year-old woman diagnosed with unifocal (<10 mm) PTMC. Relevant data were extracted after an extensive literature review, and the cost incurred in each state was determined using China Medicare data on payments for ES and AS. The willingness-to-pay threshold was set at ¥242,928/quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to account for any uncertainty in the model's variables. Additional subgroup analyses were performed to determine whether AS was cost-effective when different initial monitoring ages were used.ES exhibited an effectiveness of 5.2 QALYs, whereas AS showed an effectiveness of 25.8 QALYs. Furthermore, the incremental cost-effectiveness ratio for ES versus AS was ¥1,009/QALY. The findings of all sensitivity analyses were robust. Compared with ES, AS was found to be the cost-effective strategy at initial monitoring ages of 20 and 60 years, with an incremental cost-effectiveness ratio of ¥3,431/QALY and -¥1,316/QALY at 20 and 60 years, respectively. AS was a more cost-effective strategy in patients with PTMC aged more than 60.With respect to the norms of the Chinese healthcare system, AS was more cost-effective for PTMC over lifetime surveillance than ES. Furthermore, it was cost-effective even when the initial monitoring ages were different. In addition, if AS is incorporated into the management plan for PTMC in China at the earliest possible stage, a predicted savings of ¥10 × 108/year could be enabled for every 50,000 cases of PTMC, which indicates a good economic return for future management programs. The identification of such nuances can help physicians and patients determine the best and most individualized long-term management strategy for low-risk PTMC.Copyright © 2023 Lai, Zhang, Qin, An, Li and Yuan.