Is There a Role for Molecular Testing for Low-Risk Differentiated Thyroid Cancer? A Cost-Effectiveness Analysis

Area of Science:

• Endocrinology
• Oncology
• Health Economics

Background:

• Molecular testing for thyroid nodules is evolving to predict malignancy and aggressive features.
• Current use focuses on malignancy prediction, with developing roles in management guidance.
• High costs and long-term cancer data limit real-world studies on molecular testing.

Purpose of the Study:

• To evaluate the cost-effectiveness of molecular testing for low-risk differentiated thyroid cancer (lrDTC).
• To compare a management strategy using genetic tests (GT) versus standard care without genetic tests (wGT).

Main Methods:

• A Markovian decision tree model simulated a cohort of lrDTC patients.
• GT strategy stratified patients into low, intermediate, and high-risk groups for distant metastasis.
• Management varied based on risk: hemithyroidectomy (HT) for low-risk, total thyroidectomy (TT) +/- neck dissection for intermediate/high-risk; wGT strategy used standard HT.

Main Results:

• Genetic testing (GT) was cost-effective, gaining 1.7 quality-adjusted life years (QALYs) per patient.
• GT incurred an additional cost of $327 per patient, with an incremental cost-effectiveness ratio of $190 per QALY.
• Sensitivity analysis confirmed robust results; TT over HT for intermediate/high-risk patients was most impactful.

Conclusions:

• Molecular testing for lrDTC is a cost-effective strategy.
• Genetic profiling enables personalized management, aligning treatment with individual risk levels.
• This tailored approach improves patient outcomes in low-risk differentiated thyroid cancer.