Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Department of Health Policy, London School of Economics, London, England, UK.
Acad Radiol. 2024 Oct;31(10):3993-4010. doi: 10.1016/j.acra.2024.04.004. Epub 2024 Apr 27.
Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules.
A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5% per annum were utilized. Scenario, deterministic and probabilistic sensitivity analyses were performed. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per quality-adjusted life year (QALY) gained.
For the base case scenario, TIRADS dominated the ATA2015 strategy by a slim margin, producing 0.005 more QALYs at $25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time.
The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules.
甲状腺结节是一种常见的偶然影像学发现，容易过度诊断。已经开发了几种风险分层系统来减少不必要的检查，其中两个最常用的系统包括美国甲状腺协会 2015 年（ATA2015）和更新的美国放射学院甲状腺成像、报告和数据系统（TIRADS）指南。本研究的目的是评估 ATA2015 与 TIRADS 指南在管理偶然甲状腺结节中的成本效益。
使用决策树模型进行成本效益分析，评估偶然甲状腺结节<4cm 的成年患者。模型输入使用已发表的文献、观察性数据和专家意见进行填充。采用单一支付者视角、加元货币、五年时间范围、50,000 加元的意愿支付（WTP）阈值和每年 1.5%的贴现率。进行了情景、确定性和概率敏感性分析。主要结果是增量成本效益比（ICER），表示每增加一个质量调整生命年（QALY）的增量成本。
对于基本情况，TIRADS 以微小的优势主导了 ATA2015 策略，在成本降低 25 美元的情况下，增加了 0.005 个 QALY。结果对活检的恶性率和良性结节/亚临床恶性肿瘤或监测患者的效用敏感。概率敏感性分析表明，在大多数情况下，TIRADS 是更具成本效益的选择，占 79.7%。
与 ATA2015 相比，在使用 TIRADS 指南对偶然甲状腺结节进行风险分层时，TIRADS 指南在大多数情况下可能是更具成本效益的策略，只是优势较小。
