{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:16:20Z","timestamp":1791335780027,"version":"4.3.1"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100023670","name":"Nyckelfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023670","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guidelines in healthcare should be evidence\u2010based, satisfy patient needs and improve patient outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a cost\u2013utility analysis in Graves' disease (GD) and estimated incremental costs after the introduction of a national guideline adding the Graves' Recurrent Events After Therapy (GREAT) score with genetic determinants (GREAT+) to predict recurrence, a thyroid nurse, preoperative calcium\/vitamin D treatment and thyroid\u2010stimulating immunoglobulins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Antithyroid drugs (ATDs) were less costly, achieved 0.88 quality\u2010adjusted life years (QALYs) over 8\u2009years and dominated over radioactive iodine (RAI) treatment. The relevant incremental cost\u2010effectiveness ratio was ATD versus thyroid surgery (Tx). Tx was more costly than ATD but was also more effective. The incremental cost\u2010effectiveness ratio was equal to 40,488 Euro per QALY gained. In recurrent GD, the QALY weight for surgery after ATD was 0.76 compared with 0.79 when surgery was the initial treatment. If individuals requiring surgery could be identified at start of first treatment, QALYs would be higher (6.32) and the cost lower (13,945 Euro). The net cost increase after the new guideline was 17.6%, which was partially an effect from more time being spent with the thyroid nurse. If the GREAT+ score was also applied, the total increased net cost was 14.8% if 24% of the tested patients changed treatment to Tx.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Tx was more cost\u2010effective than RAI when ablative treatment is advocated. Prediction score for recurrence directing patients to earlier Tx is cost\u2010effective and enables the introduction of a specialist thyroid nurse. Health economic evaluations should accompany future guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70034","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T13:23:11Z","timestamp":1740144191000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of Cost and Treatment Effects in the Care Given for Graves' Disease: A Swedish Cost\u2013Utility Analysis"],"prefix":"10.1002","volume":"8","author":[{"given":"Lars","family":"Lindholm","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Global Health Ume\u00e5 University  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-8503","authenticated-orcid":false,"given":"Gabriel","family":"Sj\u00f6lin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro 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Hyperthyroidism Swedish Knowledge Organisation, Region V\u00e4sterbotten  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"TT\u201012 Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena Filipsson","family":"Nystr\u00f6m","sequence":"additional","affiliation":[{"name":"National Task Force for Hyperthyroidism Swedish Knowledge Organisation, Region V\u00e4sterbotten  Ume\u00e5 Sweden"},{"name":"Institute of Medicine, Sahlgrenska Academy, University of Gothenburg  G\u00f6teborg Sweden"},{"name":"Department of Endocrinology Sahlgrenska University Hospital  G\u00f6teborg Sweden"},{"name":"Wallenberg Centre for Molecular and Translational Medicine University of Gothenburg  G\u00f6teborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"\u201cOm kunskapsstyrningn 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