Lobectomy is a more Cost-Effective Option than Total Thyroidectomy for 1 to 4 cm Papillary Thyroid Carcinoma that do not Possess Clinically Recognizable High-Risk Features. 
Although lobectomy is a viable alternative to total thyroidectomy (TT) in low-risk 1 to 4 cm papillary thyroid carcinoma (PTC), lobectomy is associated with higher locoregional recurrence risk and need for completion TT upon discovery of a previously unrecognized histologic high-risk feature (HRF).  The present study evaluated long-term cost-effectiveness between lobectomy and TT.  Our base case was a hypothetical female cohort aged 40 years with a low-risk 2.5 cm PTC.  A Markov decision tree model was constructed to compare cost-effectiveness between lobectomy and TT after 25 years.  Patients with an unrecognized HRF (including aggressive histology, microscopic extrathyroidal extension, lymphovascular invasion, positive resection margin, nodal metastasis >5 mm, and multifocality) underwent completion TT after lobectomy.  Outcome probabilities, utilities, and costs were estimated from the literature.  The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year (QALY).  Sensitivity and threshold analyses were used to examine model uncertainty.  After 25 years, each patient who underwent lobectomy instead of TT cost an extra US$772.08 but gained an additional 0.300 QALY.  The incremental cost-effectiveness ratio was US$2577.65/QALY.  In the sensitivity analysis, the lobectomy arm began to become cost-effective only after 3 years.  Despite varying the reported prevalence of clinically unrecognized HRFs, complication from surgical procedures, annualized recurrence rates, unit cost of surgical procedure or complication, and utility score, lobectomy remained more cost-effective than TT.  Despite the higher locoregional recurrence risk and having almost half of the patients undergoing completion TT after lobectomy upon discovery of a previously unrecognized HRF, initial lobectomy was a more cost-effective long-term option than initial TT for 1 to 4 cm PTCs without clinically recognized HRFs.