Section of Thoracic Surgery, Providence Cancer Institute, Portland, USA.
Department of Otolaryngology, University of Utah, Salt Lake City, USA.
J Otolaryngol Head Neck Surg. 2022 Dec 21;51(1):46. doi: 10.1186/s40463-022-00604-7.
Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15-30% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, these tests are associated with significant costs. The objective of this study was to evaluate the cost-effectiveness of Afirma, a commercially available molecular test, in cytologically indeterminate thyroid nodules.
The base case was a solitary thyroid nodule with no additional high-risk features and an indeterminate FNA. Decision tree analysis was performed from the single payer perspective with a 1-year time horizon. Costing data were collected through micro-costing methodology. A probabilistic sensitivity analysis was performed. The primary outcome was the incremental cost effectiveness ratio (ICER) of cost per thyroid surgery avoided.
Over 1 year, mean cost estimates were $8176.28 with 0.58 effectiveness for the molecular testing strategy and $6016.83 with 0.07 effectiveness for current standard management. The ICER was $4234.22 per surgery avoided. At a willingness-to-pay (WTP) threshold of $5000 per surgery avoided, molecular testing is cost-effective with 63% certainty.
This cost-effectiveness analysis suggests utilizing Afirma for indeterminate solitary thyroid nodules is a cost-effective strategy for avoiding unnecessary thyroid surgery. With a $5000 WTP threshold, molecular testing has a 63% chance of being the more cost-effective strategy. The cost effectiveness varies based on the cost of the molecular test and the value of Afirma for patients with indeterminate thyroid nodules depends on the WTP threshold to avoid unnecessary thyroid surgery.
甲状腺结节影响多达 65%的人群。虽然细针抽吸（FNA）细胞学是诊断的金标准，但 15-30%的结果是不确定的。分子检测可能有助于诊断结节，并可能减少不必要的手术。然而，这些测试与重大成本有关。本研究的目的是评估 Afirma （一种商业上可获得的分子检测）在细胞学不确定的甲状腺结节中的成本效益。
基础病例为一个无其他高危特征的孤立性甲状腺结节和不确定的 FNA。决策树分析是从单一支付者的角度进行的，时间范围为 1 年。成本数据通过微观成本法收集。进行了概率敏感性分析。主要结果是避免甲状腺手术的增量成本效益比（ICER）。
在 1 年内，分子检测策略的平均成本估计为 8176.28 美元，效果为 0.58；而目前标准管理的平均成本估计为 6016.83 美元，效果为 0.07。避免手术的 ICER 为 4234.22 美元。在避免手术的意愿支付（WTP）阈值为 5000 美元的情况下，分子检测的成本效益为 63%。
这项成本效益分析表明，对于不确定的孤立性甲状腺结节，使用 Afirma 是避免不必要甲状腺手术的一种具有成本效益的策略。在 5000 美元的 WTP 阈值下，分子检测更具成本效益的可能性为 63%。成本效益取决于分子检测的成本和 Afirma 对不确定甲状腺结节患者的价值，取决于避免不必要甲状腺手术的 WTP 阈值。
