Cost-Effectiveness Analysis of Antithyroid Drug (Propylthiouracil) Compared to Radioactive Iodine for the Treatment of Graves’ Disease in Ethiopia

BACKGROUND: Graves’ disease is an autoimmune disorder caused by stimulating antibodies. The peak incidence of Graves’ disease occurs among patients aged 30 to 60 years. Radioactive iodine (RAI) and antithyroid drug (ATD) have been well-established therapies for the treatment of Graves’ disease for several decades. However, there remain large variations in practice among physicians in the preferred modality and the method of administration. OBJECTIVE: To assess the cost-effectiveness of ATD (propylthiouracil) compared to RAI from a health care payer perspective in Ethiopia. METHODS: Markov model was constructed by using TreeAge software 2021 with different parameters, such as ATD, RAI, treatment failure, treatment success, hypothyroidism, and supplemental thyroxine to conduct a cost-effectiveness analysis. A hypothetical 40-year-old female patient with symptomatic Graves’ hyperthyroidism was simulated to estimate expected lifetime health outcomes, quality-adjusted life years (QALYs) and costs, discounted at 3%. RESULTS: RAI has lesser QALYs (14.19) and is less expensive (US$ 3583.22), while ATD has higher QALYs (16.54) and is more expensive (US$ 12531.68). The result showed that there was no dominant treatment option. The incremental cost-effectiveness ratio was US$ 3811.6 per QALY which was greater than one to three times the cost-effectiveness threshold of Ethiopia (US$ 783). CONCLUSION: In this cost-effectiveness analysis, RAI was the preferred treatment strategy for Graves’ disease, since the cost needed to get one extra QALY through ATD was greater than one to three times the cost-effectiveness threshold of Ethiopia.