Cost-Effectiveness of Using a Molecular Diagnostic Test to Improve Preoperative Diagnosis of Thyroid Cancer

Abstract

Assuming 95% sensitivity and specificity of the Dx test when used as an adjunct to FNAB, the utilization of the DX test resulted in a gain of 0.046 quality-adjusted life-years (95% confidence interval 0.019-0.078) and a saving of $1087 (95% confidence interval $691-$1533) in direct costs per patient. If the cost of the Dx test is less than $1087 per test, we expect to save quality-adjusted life-years and reduce costs when it is utilized. Sensitivity of the DX test, compared with specificity, had a larger influence on the overall outcomes.

Cost-Effectiveness of Molecular Testing for Thyroid Nodules With Atypia of Undetermined Significance Cytology

“…Patients with a false-negative result (ie, malignant pathology falsely diagnosed as benign) would therefore be at risk of delayed diagnosis and treatment. These patients may be at increased risk of recurrence and cancer-specific mortality (12,13). Patients with a positive test proceed with the standard management, that is, diagnostic thyroid lobectomy, followed by completion thyroidectomy if malignant.…”

Differential expression of transforming growth factor-beta in benign vs. papillary thyroid cancer nodules; a potential diagnostic tool?

“…Attaining an accurate preoperative diagnosis of a thyroid nodule can prove difficult due to the lack of specific diagnostic tests for thyroid cancer. Consequently, 40-60% of thyroid surgery is performed for diagnostic purposes after non-diagnostic FNA cytology [[4]–[6]]. A specific molecular marker for thyroid cancer screening is desirable to avoid the resource burden of potentially avoidable surgery.…”

“…A recent cost analysis simulation examined the expected cost savings with the utilization of a diagnostic molecular marker for thyroid cancer in cases of indeterminate FNA cytology. Assuming a sensitivity and specificity of 95%, this study found that utilization of such a marker would result in a savings of $1087 in direct costs per patient as well as a significant gain in quality adjusted life years [[4]]. Costs to a publicly funded health care system were not addressed.…”

“…Of these 2-51% will be malignant [[3]–[5]]. Current recommendations in the management of patients with non-diagnostic FNAs advocate repeating the FNA, or pursuing hemithyroidectomy for definitive pathological diagnosis [[2],[4]]. Consequently, a large portion of thyroid surgery (40-60%) is performed on what is later diagnosed as benign disease [[4]–[6]].…”

“…Current recommendations in the management of patients with non-diagnostic FNAs advocate repeating the FNA, or pursuing hemithyroidectomy for definitive pathological diagnosis [[2],[4]]. Consequently, a large portion of thyroid surgery (40-60%) is performed on what is later diagnosed as benign disease [[4]–[6]]. Development of reliable and accurate pre-operative diagnostic tests to differentiate thyroid cancer from benign thyroid nodules is critical to reduce unnecessary cost to our health care system, and potential patient morbidity.…”