Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules
Abstract Background Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15–30% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, the...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-12-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | https://doi.org/10.1186/s40463-022-00604-7 |
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| author | Navjit Dharampal Kristine Smith Adrian Harvey Ralf Paschke Luke Rudmik Shamir Chandarana |
| author_facet | Navjit Dharampal Kristine Smith Adrian Harvey Ralf Paschke Luke Rudmik Shamir Chandarana |
| author_sort | Navjit Dharampal |
| collection | DOAJ |
| description | Abstract Background Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15–30% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, these tests are associated with significant costs. The objective of this study was to evaluate the cost-effectiveness of Afirma, a commercially available molecular test, in cytologically indeterminate thyroid nodules. Methods The base case was a solitary thyroid nodule with no additional high-risk features and an indeterminate FNA. Decision tree analysis was performed from the single payer perspective with a 1-year time horizon. Costing data were collected through micro-costing methodology. A probabilistic sensitivity analysis was performed. The primary outcome was the incremental cost effectiveness ratio (ICER) of cost per thyroid surgery avoided. Results Over 1 year, mean cost estimates were $8176.28 with 0.58 effectiveness for the molecular testing strategy and $6016.83 with 0.07 effectiveness for current standard management. The ICER was $4234.22 per surgery avoided. At a willingness-to-pay (WTP) threshold of $5000 per surgery avoided, molecular testing is cost-effective with 63% certainty. Conclusion This cost-effectiveness analysis suggests utilizing Afirma for indeterminate solitary thyroid nodules is a cost-effective strategy for avoiding unnecessary thyroid surgery. With a $5000 WTP threshold, molecular testing has a 63% chance of being the more cost-effective strategy. The cost effectiveness varies based on the cost of the molecular test and the value of Afirma for patients with indeterminate thyroid nodules depends on the WTP threshold to avoid unnecessary thyroid surgery. Graphical Abstract |
| format | Article |
| id | doaj-art-bf15c7ce08f244aaa7fcebbcddf332e1 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-bf15c7ce08f244aaa7fcebbcddf332e12025-01-03T01:45:48ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162022-12-015111910.1186/s40463-022-00604-7Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodulesNavjit Dharampal0Kristine Smith1Adrian Harvey2Ralf Paschke3Luke Rudmik4Shamir Chandarana5Section of Thoracic Surgery, Providence Cancer InstituteDepartment of Otolaryngology, University of UtahSection of General Surgery, Department of Surgery, University of CalgaryDivision of Endocrinology, University of CalgarySection of Otolaryngology, Department of Surgery, University of Calgary, Foothills Medical CentreSection of Otolaryngology, Department of Surgery, University of Calgary, Foothills Medical CentreAbstract Background Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15–30% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, these tests are associated with significant costs. The objective of this study was to evaluate the cost-effectiveness of Afirma, a commercially available molecular test, in cytologically indeterminate thyroid nodules. Methods The base case was a solitary thyroid nodule with no additional high-risk features and an indeterminate FNA. Decision tree analysis was performed from the single payer perspective with a 1-year time horizon. Costing data were collected through micro-costing methodology. A probabilistic sensitivity analysis was performed. The primary outcome was the incremental cost effectiveness ratio (ICER) of cost per thyroid surgery avoided. Results Over 1 year, mean cost estimates were $8176.28 with 0.58 effectiveness for the molecular testing strategy and $6016.83 with 0.07 effectiveness for current standard management. The ICER was $4234.22 per surgery avoided. At a willingness-to-pay (WTP) threshold of $5000 per surgery avoided, molecular testing is cost-effective with 63% certainty. Conclusion This cost-effectiveness analysis suggests utilizing Afirma for indeterminate solitary thyroid nodules is a cost-effective strategy for avoiding unnecessary thyroid surgery. With a $5000 WTP threshold, molecular testing has a 63% chance of being the more cost-effective strategy. The cost effectiveness varies based on the cost of the molecular test and the value of Afirma for patients with indeterminate thyroid nodules depends on the WTP threshold to avoid unnecessary thyroid surgery. Graphical Abstracthttps://doi.org/10.1186/s40463-022-00604-7Cost-effectiveness analysisMolecular testingAfirmaIndeterminate thyroid nodule |
| spellingShingle | Navjit Dharampal Kristine Smith Adrian Harvey Ralf Paschke Luke Rudmik Shamir Chandarana Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules Journal of Otolaryngology - Head and Neck Surgery Cost-effectiveness analysis Molecular testing Afirma Indeterminate thyroid nodule |
| title | Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules |
| title_full | Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules |
| title_fullStr | Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules |
| title_full_unstemmed | Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules |
| title_short | Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules |
| title_sort | cost effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules |
| topic | Cost-effectiveness analysis Molecular testing Afirma Indeterminate thyroid nodule |
| url | https://doi.org/10.1186/s40463-022-00604-7 |
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