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ThyroSeq®V2.0 Molecular Testing: A Cost-Effective Approach for the Evaluation of Indeterminate Thyroid Nodules
Objective:
Approximately 15 to 30% of thyroid nodules have indeterminate cytology. Many of these nodules are treated surgically, but only 5 to 30% are malignant. Molecular testing can further narrow the risk of malignancy of these nodules. Our objective was to assess the cost effectiveness of ThyroSeq®V2.0 compared to diagnostic thyroidectomy for the evaluation of indeterminate nodules.
Methods:
Cytology and histopathology slides of Bethesda category III and IV (suspicious for follicular neoplasia [SFN]) nodules obtained between January 1, 2014 and November 30, 2016 were re-reviewed by 2 endocrine cytopathologists. Costs for a diagnostic approach using ThyroSeq® were calculated and compared to those of diagnostic thyroidectomy.
Results:
We included 8 Bethesda category III nodules that underwent ThyroSeq® and 8 that underwent diagnostic surgery. Of those submitted for ThyroSeq®, 4 were positive for mutations and underwent thyroid surgery. The average cost per nodule evaluated was $14,669 using ThyroSeq®, compared to $23,338 for diagnostic thyroid surgery. The cost per thyroid cancer case detected was $58,674 using ThyroSeq® compared to $62,233 for diagnostic thyroid surgery. We included 13 nodules Bethesda category IV that underwent ThyroSeq® and 11 that underwent diagnostic surgery. Of those submitted for ThyroSeq®, 6 were positive for mutation and underwent thyroid surgery. The average costs per nodule evaluated were $14,641 using ThyroSeq® and $24,345 using diagnostic thyroidectomy. The cost per thyroid cancer case detected was $31,721 when using ThyroSeq® compared to $53,560 for diagnostic thyroidectomy.
Conclusion:
The use of ThyroSeq® in our institution is cost effective compared to diagnostic thyroid surgery for the evaluation of Bethesda categories III and IV (SFN) nodules.
Abbreviations:
FNA = fine-needle aspiration; GEC = gene expression classifier; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; PTC = papillary thyroid cancer; SFN = suspicious for follicular neoplasia.
Insights
ThyroSeq®V2.0 molecular testing is more cost-effective than diagnostic thyroidectomy for indeterminate thyroid nodules (Bethesda categories III and IV). This approach offers a lower average cost per nodule and per cancer case detected.
Area of Science:
- Endocrinology
- Oncology
- Molecular Diagnostics
Background:
- Indeterminate thyroid nodules (Bethesda III/IV) present a diagnostic challenge, with many undergoing unnecessary surgery.
- Molecular testing aids in risk stratification, potentially reducing surgical intervention.
- ThyroSeq®V2.0 is a molecular test for evaluating these nodules.
Purpose of the Study:
- To assess the cost-effectiveness of ThyroSeq®V2.0 compared to diagnostic thyroidectomy for indeterminate thyroid nodules.
- To evaluate the economic impact of molecular testing in thyroid nodule management.
Main Methods:
- Retrospective review of Bethesda category III and IV nodules from January 2014 to November 2016.
- Comparison of costs associated with ThyroSeq®V2.0 testing versus diagnostic thyroidectomy.
- Analysis of cost per nodule evaluated and cost per cancer case detected.
Main Results:
- For Bethesda III nodules, ThyroSeq®V2.0 averaged $14,669/nodule vs. $23,338 for surgery; cost per cancer was $58,674 vs. $62,233.
- For Bethesda IV nodules, ThyroSeq®V2.0 averaged $14,641/nodule vs. $24,345 for surgery; cost per cancer was $31,721 vs. $53,560.
- ThyroSeq®V2.0 demonstrated lower costs in both evaluated categories.
Conclusions:
- ThyroSeq®V2.0 is a cost-effective diagnostic tool for indeterminate thyroid nodules (Bethesda III/IV).
- Molecular testing can reduce healthcare costs associated with unnecessary thyroid surgeries.
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