FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial

Area of Science:

• Nuclear medicine
• Oncology
• Health economics

Background:

• Thyroid nodules with Bethesda III/IV cytology present a diagnostic challenge, often leading to unnecessary surgeries.
• [¹⁸F]FDG-PET/CT imaging offers a non-invasive method for evaluating these nodules.
• Assessing the cost-effectiveness of [¹⁸F]FDG-PET/CT compared to diagnostic surgery is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the cost-effectiveness of an [¹⁸F]FDG-PET/CT-driven diagnostic workup versus diagnostic surgery for thyroid nodules with Bethesda III/IV cytology.
• To determine if [¹⁸F]FDG-PET/CT can reduce futile diagnostic surgeries for benign nodules.
• To analyze the long-term societal costs and quality-adjusted life years (QALYs) associated with each diagnostic approach.

Main Methods:

• A randomized controlled multicentre trial involving 132 patients compared [¹⁸F]FDG-PET/CT to diagnostic surgery.
• Lifelong societal costs and QALYs were assessed using a Markov model based on 1-year trial results.
• Cost-effectiveness acceptability curves were used to estimate the probability of cost-effectiveness, accounting for uncertainties.

Main Results:

• The [¹⁸F]FDG-PET/CT workup resulted in a 1-year cost reduction of €1000 for thyroid nodule-related care and €4500 from a societal perspective.
• Over a modeled lifelong period, the cost difference was -€9900, with a QALY difference of 0.402.
• At a willingness to pay of €50,000 per QALY, [¹⁸F]FDG-PET/CT was the cost-effective strategy with 84% certainty.

Conclusions:

• An [¹⁸F]FDG-PET/CT-driven diagnostic workup significantly reduces costs for thyroid nodule management in Bethesda III/IV cases.
• This imaging approach avoids unnecessary surgeries, thereby lowering healthcare expenditures and improving patient outcomes.
• [¹⁸F]FDG-PET/CT is a highly probable cost-effective strategy compared to diagnostic surgery for Bethesda III/IV thyroid nodules.