Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules

Area of Science:

• Endocrinology
• Surgical Oncology
• Health Economics

Background:

• Thyroid nodules are common, with 15-30% of fine needle aspirates (FNA) yielding indeterminate results.
• Molecular testing can aid diagnosis but incurs significant costs.
• Evaluating the cost-effectiveness of molecular tests like Afirma for indeterminate nodules is crucial.

Purpose of the Study:

• To assess the cost-effectiveness of the Afirma molecular test for cytologically indeterminate thyroid nodules.
• To determine the incremental cost-effectiveness ratio (ICER) of avoiding thyroid surgery.

Main Methods:

• Decision tree analysis from a single-payer perspective over a 1-year horizon.
• Micro-costing methodology for data collection.
• Probabilistic sensitivity analysis to evaluate the ICER.

Main Results:

• Molecular testing strategy cost: $8176.28 (0.58 effectiveness). Standard management cost: $6016.83 (0.07 effectiveness).
• Incremental Cost-Effectiveness Ratio (ICER): $4234.22 per surgery avoided.
• At a $5000 willingness-to-pay (WTP) threshold, molecular testing is cost-effective with 63% certainty.

Conclusions:

• Afirma utilization for indeterminate solitary thyroid nodules is a cost-effective approach to prevent unnecessary surgeries.
• Molecular testing demonstrates a 63% probability of being more cost-effective at a $5000 WTP threshold.
• The cost-effectiveness is contingent on the molecular test's price and the WTP threshold for avoiding surgery.