Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Clin Endocrinol (Oxf). 2021 Apr;94(4):717-724. doi: 10.1111/cen.14400. Epub 2021 Jan 10.
Thyroid nodules of indeterminate cytology can be subjected to molecular testing such as the Afirma Genomic Sequencing Classifier (GSC), thereby minimizing the number of unnecessary diagnostic surgeries.
This work aimed to evaluate and compare the cost of routine GSC testing of indeterminate thyroid nodules in different countries.
DESIGN, PATIENTS AND MAIN OUTCOME MEASURES: The cost of diagnostic hemithyroidectomy of indeterminate thyroid nodules was calculated by performing a Monte Carlo simulation cost analysis on a Markov decision-analytic model and then compared to that of GSC testing in the UK, Australia, USA, and Israel.
Assuming that patients are treated by surgical resection and routine GSC testing is performed for all nodules of indeterminate significance, we found the GSC test to be more cost effective compared with diagnostic hemithyroidectomy when malignancy rates of thyroid nodules are less than 22.6%-37.1%, depending on the country where the test is performed. Given the cost of a thyroidectomy in the UK, Australia and Israel, performing routine GSC tests on all Bethesda IV nodules is more expensive than routine diagnostic hemithyroidectomy and becomes cost effective for Bethesda III when the GSC cost is below 3,031-3,087 USD. In comparison, in the USA, higher cost of thyroidectomy makes the GSC test cost effective for Bethesda III nodules at its current cost, but not for Bethesda IV nodules where it becomes cost effective under the price of 3,031 USD.
Different molecular testing and surgical costs in different countries should be considered when performing cost analysis. In addition, since different medical centres have different malignancy rates, personalized in-house assessment of cost-effectiveness is warranted.
甲状腺结节的细胞学检查结果不明确时，可以进行分子检测，如 Afirma 基因组测序分类器（GSC），从而减少不必要的诊断性手术数量。
本研究旨在评估和比较不同国家对甲状腺不明确结节进行常规 GSC 检测的成本。
设计、患者和主要观察指标：通过对马尔可夫决策分析模型进行蒙特卡罗模拟成本分析，计算出甲状腺不明确结节诊断性甲状腺叶切除术的成本，然后与英国、澳大利亚、美国和以色列的 GSC 检测成本进行比较。
假设患者接受手术切除治疗，对所有意义不明确的结节进行常规 GSC 检测，当甲状腺结节恶性率低于 22.6%-37.1%时，GSC 检测比诊断性甲状腺叶切除术更具成本效益，具体取决于检测所在的国家。考虑到英国、澳大利亚和以色列的甲状腺切除术成本，如果对所有 Bethesda IV 结节进行常规 GSC 检测，其费用高于常规诊断性甲状腺叶切除术，当 GSC 检测费用低于 3031-3087 美元时，对 Bethesda III 结节进行常规 GSC 检测则具有成本效益。相比之下，在美国，由于甲状腺切除术的费用较高，GSC 检测对当前成本下的 Bethesda III 结节具有成本效益，但对 Bethesda IV 结节不具有成本效益，只有当 GSC 检测费用低于 3031 美元时才具有成本效益。
在进行成本分析时，应考虑不同国家的不同分子检测和手术成本。此外，由于不同的医疗中心具有不同的恶性率，因此需要进行个性化的成本效益评估。
