Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
J Clin Endocrinol Metab. 2011 Nov;96(11):E1719-26. doi: 10.1210/jc.2011-0459. Epub 2011 Aug 24.
Determining which patients with thyroid nodules require surgery is limited by cytologically indeterminate findings. A new approach for preoperative molecular classification of cytologically indeterminate thyroid nodules has a reported sensitivity of 91% and specificity of 75%; however, its cost-effectiveness has yet to be assessed.
Our objective was to evaluate the 5-yr cost-effectiveness of routine use of a molecular test in adult patients with indeterminate fine-needle aspiration biopsy results from a societal perspective.
A 16-state Markov decision model was developed. Probabilities, costs, and quality-adjusted life years (QALY) were estimated from literature review, U.S. Department of Health and Human Services data, Medicare reimbursement schedules, and expert opinion.
Decision analysis of a hypothetical group of adult patients with cytologically indeterminate thyroid nodules was conducted.
Incremental cost-effectiveness ratio was calculated as incremental cost (measured in U.S. dollars) divided by incremental effectiveness (measured in QALY).
Modifying current practice with use of the molecular test resulted in 74% fewer surgeries for benign nodules with no greater number of untreated cancers. Over 5 yr, mean discounted cost estimates were $12,172 for current practice and $10,719 with the molecular test. Current practice and molecular test use produced 4.50 and 4.57 QALY, respectively.
Use of this novel molecular test for differential diagnosis of cytologically indeterminate thyroid nodules can potentially avoid almost three fourths of currently performed surgeries in patients with benign nodules. Compared with current practice based on cytological findings alone, use of this test may result in lower overall costs and modestly improved quality of life for patients with indeterminate thyroid nodules.
甲状腺结节患者中，有一部分患者的细胞学检查结果不确定，需要手术治疗。目前有一种新的术前分子分类方法，其细胞学不确定的甲状腺结节的诊断敏感性为 91%，特异性为 75%；然而，其成本效益尚未得到评估。
从社会角度评估常规使用分子检测对细胞学不确定的细针抽吸活检结果的成年患者进行 5 年成本效益分析。
建立了一个 16 状态的马尔可夫决策模型。通过文献回顾、美国卫生与公众服务部数据、医疗保险报销表和专家意见，估算了概率、成本和质量调整生命年（QALY）。
对一组具有细胞学不确定的甲状腺结节的成年患者进行了决策分析。
计算增量成本效益比，即增量成本（以美元计）除以增量效果（以 QALY 计）。
通过使用分子检测改变当前的实践方法，良性结节的手术数量减少了 74%，而未治疗的癌症数量没有增加。在 5 年期间，当前实践的平均贴现成本估计为 12172 美元，而使用分子检测的成本为 10719 美元。当前实践和分子检测的使用分别产生了 4.50 和 4.57 个 QALY。
使用这种新型的分子检测对细胞学不确定的甲状腺结节进行鉴别诊断，可以避免目前在良性结节患者中进行的近四分之三的手术。与单独基于细胞学发现的当前实践相比，使用这种检测方法可能会降低总体成本，并适度提高具有不确定甲状腺结节患者的生活质量。
