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ABSTRACT Objective To compare the long-term medical costs of active surveillance (AS), partial thyroidectomy (PT), and total thyroidectomy (TT) in patients with low-risk papillary thyroid microcarcinoma (PTMC) receiving care covered by the Brazilian Public Health System. Materials and methods After reviewing AS cohorts and our own data, we created a model of AS, PT, and TT flow care for low-risk PTMC over 10, 20, and 30 years. The medical costs included those associated with diagnosis, surgery, and follow-up. We considered that 13.3% of the patients on AS would require surgery after a mean of 21.3 months, 4% undergoing TT would develop permanent hypoparathyroidism, and 43% undergoing PT would develop hypothyroidism. Results The most economical alternative was AS. The costs of TT per patient were higher than those of AS by 182.8% over 10 years (866.89 versus 306.49 US dollars [USD], respectively), by 152.9% over 20 years (1,023.66 versus 404.73 USD, respectively), and by 134.7% over 30 years (1,180.42 versus 502.96 USD, respectively). The costs of PT per patient were higher than those of AS by 16.0% over 10 years (355.66 versus 306.49 USD, respectively), by 16.9% over 20 years (473.41 versus 404.73 USD, respectively), and by 17.5% over 30 years (591.17 versus 502.96 USD, respectively). Conclusion The AS approach was less costly than immediate surgery throughout 30 years of follow-up. Hence, the implementation of AS in Brazil should not be hindered by cost considerations. longterm long term , (AS) (PT) (TT lowrisk low risk (PTMC System data 3 diagnosis followup. followup follow up. up follow-up 133 13 13.3 213 21 21. months 4 hypoparathyroidism 43 hypothyroidism 1828 182 8 182.8 1 866.89 86689 866 89 (866.8 30649 306 49 306.4 USD [USD] respectively, respectively respectively) 1529 152 9 152.9 2 1,023.66 102366 023 66 (1,023.6 40473 404 73 404.7 1347 134 7 134.7 1,180.42 118042 180 42 (1,180.4 50296 502 96 502.9 respectively. . 160 16 0 16.0 355.66 35566 355 (355.6 169 16.9 473.41 47341 473 41 (473.4 175 17 5 17.5 591.17 59117 591 (591.1 Hence considerations (AS (PT 13. 18 182. 866.8 8668 86 (866. 3064 306. [USD 15 152. 1,023.6 10236 02 6 (1,023. 4047 40 404. 134. 1,180.4 11804 (1,180. 5029 50 502. 16. 355.6 3556 35 (355. 473.4 4734 47 (473. 17. 591.1 5911 59 (591. 866. (866 1,023. 1023 (1,023 1,180. 1180 (1,180 355. (355 473. (473 591. (591 (86 1,023 102 (1,02 1,180 118 (1,18 (35 (47 (59 (8 1,02 (1,0 1,18 11 (1,1 (3 (4 (5 ( 1,0 (1, 1,1 1, (1