Cost effectiveness analysis of BRAF^V600E testing for low-risk papillary thyroid microcarcinomas

Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs), accurate risk stratification is valuable to optimize management: active surveillance (AS) vs. hemithyroidectomy (HT). BRAF^V600E positive lrPTMC is associated with increased recurrence risk; hence, AS was suggested for mutation-negative lrPTMC. This study aims to evaluate the cost-effectiveness of BRAF^V600E testing for lrPTMC.

Decision tree cost-effectiveness analytic model.

We performed a cost-effectiveness analysis of the management strategies for lrPTMCs: AS, HT, and BRAF^V600E genetic testing (GT), in which treatment pathways were determined by BRAF^V600E status. Data on probabilities and complications were derived from current literature. One- and two-way sensitivity analyses were conducted to ascertain model robustness.

Our model found GT as the cost-effective strategy, providing an additional 0.35 QALYs and an additional cost of $902 with an Incremental Cost-effectiveness ratio of $2542 compared to AS. In contrast, surgical intervention showed a lower utility with an increased cost of $381, positioning GT as the preferred strategy. Sensitivity analysis identified age at diagnosis as the most influential factor for cost-effectiveness between AS and GT; younger patients exhibited a lower ICER, indicating greater cost savings per QALY, till up to age 48 years, where AS becomes favorable. GT consistently outperformed QALY gains across varying incidences of BRAF^V600E positivity tumors.

In conclusion, this study demonstrates the economic and clinical advantages of incorporating BRAF^V600E genetic testing in the management of lrPTMCs. Our model supports further real-life studies of BRAF^V600E testing for lrPTMCs.