Percutaneous ethanol injection in thyroid nodular pathology and metastatic cervical adenopathies: A systematic review, meta-analysis and economic evaluation

• Published in: Endocrinología, diabetes y nutrición. diabetes y nutrición., 2023-11, Vol.70 (9), p.572-583
• Main Authors: León-Salas, Beatriz, Hernández-Yumar, Aránzazu, Infante-Ventura, Diego, de Armas Castellano, Aythami, González Hernández, Yadira, Linertová, Renata, Téllez Santana, Teresa, de Pablos-Velasco, Pedro, Trujillo-Martín, María M.
• Format: Article
• Language: English
• Subjects: Ablación por radiofrecuencia; Cost-effectiveness; Coste-efectividad; Efectividad; Effectiveness; España; Inyección percutánea de etanol; Meta-analysis; Metanálisis; Patología nodular tiroidea; Percutaneous ethanol injection; Radiofrequency ablation; Safety; Seguridad; Spain; Thyroid nodular pathology
• ISSN: 2530-0180; 2530-0180
• DOI: 10.1016/j.endien.2023.08.007

Percutaneous ethanol injection (PEI) has been shown to be a valuable treatment for thyroid nodular pathology and metastatic cervical adenopathies. To evaluate the effectiveness, safety, and cost-effectiveness of PEI in thyroid nodular pathology and metastatic cervical adenopathies. A systematic review (SR) using meta-analysis was conducted on the effectiveness and safety of PEI. A SR on cost-effectiveness was also performed. The SRs were conducted according to the methodology developed by the Cochrane Collaboration with reporting in accordance with the PRISMA statement. A cost-minimization analysis was carried out using a decision tree model. Assuming equal effectiveness between two minimally invasive techniques (PEI and radiofrequency ablation (RFA)), the model compared the costs of the alternatives with a horizon of six months and from the perspective of the Spanish National Health System. The search identified three RCTs (n=157) that evaluated PEI versus RFA in patients diagnosed with benign thyroid nodules: ninety-six patients with predominantly cystic nodules and sixty-one patients with solid nodules. No evidence was found on other techniques or thyroid nodular pathology. No statistically significant differences were observed between PEI and RFA in volume reduction (%), symptom score, cosmetic score, therapeutic success and major complications. No economic evaluations were identified. The cost-minimization analysis estimated the cost per patient of the PEI procedure at €326 compared to €4781 for RFA, which means an incremental difference of −€4455. There are no differences between PEI and RFA regarding their safety and effectiveness, but the economic evaluation determined that the former option is cheaper. La inyección percutánea de etanol (IPE) ha demostrado ser un tratamiento útil para la patología nodular tiroidea y las adenopatías cervicales metastásicas. Evaluar la efectividad, la seguridad y el coste-efectividad de la IPE en la patología nodular tiroidea y las adenopatías cervicales metastásicas. Se realizó una revisión sistemática (RS) mediante un metanálisis sobre la efectividad y la seguridad de la IPE. También se realizó una RS sobre su coste-efectividad. Las RS se llevaron a cabo de acuerdo con la metodología desarrollada por la Colaboración Cochrane con la presentación de informes de acuerdo con la declaración PRISMA. Se realizó un análisis de coste-minimización mediante un modelo basado en un árbol de decisión. Asumiendo igual efectividad