Cost-Effectiveness of Thyroid Nodule Risk Stratification Guidelines

The goal of this study is to evaluate the cost savings of consistently adhering to the 2017 American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the 2015 American Thyroid Association (ATA) criteria for the evaluation of thyroid nodules. In this retrospective study, 2 radiologists independently reviewed ultrasound (US) features of 291 cytology-proven thyroid nodules and scored them based on the ACR TI-RADS and ATA guidelines. The expected costs of strict adherence to recommendations based on the 2 risk stratification guidelines were calculated and compared with the actual cost to the health care system. Strict adherence to risk stratification guidelines can save the regional health care system up to $88,000 annually based on the 291 thyroid nodules examined. With retrospective application of ACR TI-RADS criteria, 51 nodules were recommended for follow-up US and 147 for fine-needle aspiration biopsy. With ATA criteria, 9 nodules were recommended for follow-up US, and 261 for fine-needle aspirations. Although fewer nodules were recommended for biopsy with TI-RADS criteria, the majority met criteria for follow-up US. Between the two guidelines, the ACR-TI-RADS offered slightly greater savings of ∼$3000 annually compared with ATA. Strict adherence to ACR TI-RADS and ATA guidelines can lead to substantial cost savings for the health care system by eliminating unnecessary thyroid biopsies. ACR TI-RADS is more cost-effective compared with ATA.