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Cost analysis of reflexive versus selective molecular testing for indeterminate thyroid nodules
Q Lina Hu1, Max A Schumm1, Kyle A Zanocco1
1Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA.
Surgery
|July 21, 2021
Summary
Reflexive molecular testing for indeterminate thyroid nodules is more cost-effective than selective testing. This strategy reduces unnecessary surgeries for benign nodules and avoids missing malignant ones.
Area of Science:
- Endocrinology
- Surgical Oncology
- Health Economics
Background:
- Indeterminate thyroid nodules require refined diagnostic approaches.
- Molecular testing is increasingly utilized to improve diagnostic accuracy.
Purpose of the Study:
- To compare the cost-effectiveness of reflexive versus selective molecular testing strategies for indeterminate thyroid nodules.
Main Methods:
- A Markov model simulated the costs of diagnosis and treatment for indeterminate thyroid nodules.
- The model compared reflexive and selective molecular testing strategies using real-world data and Medicare fee schedules.
Main Results:
- The reflexive strategy cost $8,045 per patient versus $6,090 for the selective strategy.
- Reflexive testing reduced unnecessary diagnostic lobectomies by 2,440 and missed malignancies by 479 in 10,000 simulations.
- Molecular testing costs significantly impacted overall expenses, with a threshold of $1,050 for cost-effectiveness.
Conclusions:
- Reflexive molecular testing for indeterminate thyroid nodules is a cost-saving strategy.
- This approach helps avoid unnecessary thyroid lobectomies, saving an estimated $20,600 per avoided surgery.
