Cost-Effectiveness of Radiofrequency Ablation for Benign Non-Functioning Thyroid Nodules: A Systematic Review

This systematic review tests the hypothesis that radiofrequency ablation (RFA) for benign non-functioning thyroid nodules is associated with favourable cost-effectiveness compared with surgery.

A systematic literature search of multiple databases (Embase, Medline, Web of Science, and Cochrane Central) was conducted through 16 May 2025, with no restrictions on publication date or language. Full economic evaluations comparing RFA with alternative management strategies were included in the primary synthesis. Secondary narrative synthesis included studies reporting cost data without formal cost-effectiveness modelling. All costs were converted to 2021 US dollars to enable cross-study comparability. Incremental cost-effectiveness ratios (ICERs), net monetary benefit (NMB), and net health benefit (NHB) were calculated where data allowed.

Thirteen studies met the inclusion criteria: 3 full economic evaluations and 10 descriptive cost studies. All compared RFA to surgery. In the primary synthesis, two studies reported ICERs for RFA versus surgery, which ranged from -$14 994 (reflecting a lower cost and greater effectiveness for RFA) to $98 858 per QALY gained, with substantial variation in model design and assumptions. Post hoc estimates of NMB and NHB generally favoured RFA at $50 000 and $100 000 willingness-to-pay thresholds. In the narrative synthesis, 8 of 10 studies reported lower total costs for RFA (median: $2499) compared to surgery (median: $3579). Methodological heterogeneity limited comparability. Overall certainty of economic evidence was rated as low.

RFA may be a cost-effective alternative to surgery for benign thyroid nodules, but current economic evidence is limited and of low certainty.