**10. Do Guidelines Help Control Costs?**

Cancer guidelines focus almost exclusively on best care. Cost of care tends to not be considered at all or to be an afterthought years after the implementation. A recent study

used a microsimulation model to compare the cost-effectiveness of the revised 2015 ATA guidelines to the 2009 guidelines [99]. One of the aims of these revised guidelines was to reduce the number of total thyroidectomies and surgical complications and, therefore, potentially cost. The study illustrates that the ATA 2015 guideline patient generated greater average QALYs (13.09 vs 12.43) at a lower average cost per patient (£10,612 vs £14,386) [99].

Reducing the cost of care is not only relevant to socialised medicine since it can also have an impact on personal wellbeing and cause insecurities regarding personal wealth with the associated QoL considerations. Financial difficulties are reported by 43% of thyroid cancer survivors and are associated with worse anxiety and depression [81]. A South Korean retrospective cohort study calculated an average personal medical cost of £2547 per patient after diagnosis of thyroid cancer at 2 years [100]. Fighting cancer can be a costly battle and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help to support post-treatment cancer survivors. Incorporation of FT assessment into survivorship care planning could enhance clinical assessment of thyroid cancer patients, help address the dynamic and persistent challenges of survivorship, and help identify those most in need of intervention across the cancer care continuum [101].
