Cost Impact of Molecular Testing for Indeterminate Thyroid Nodule Fine-Needle Aspiration Biopsies

作者：Linwah Yip, Coreen A. Farris, Adam S. Kabaker, Steven P. Hodak, Marina N. Nikiforova, Kelly L. McCoy, Michael T. Stang, Kenneth J. Smith, Yuri E. Nikiforov, Sally E. Carty · 发表于：The Journal of Clinical Endocrinology & Metabolism · 年份：2012 · DOI：10.1210/jc.2011-3048 · 被引用次数：149 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid and Parathyroid Surgery、Thyroid Disorders and Treatments

INTRODUCTION: Molecular testing of fine-needle aspiration (FNA) results helps diagnose thyroid cancer, although the additional cost of this adjunct has not been studied. We hypothesized that FNA molecular testing of two indeterminate categories (follicular lesion of undetermined significance and follicular/Hürthle cell neoplasm) can be cost saving. METHODS: For a hypothetical group of euthyroid patients with a 1-cm or larger solitary thyroid nodule, a decision-tree model was constructed to compare the estimated costs of initial evaluation according to the current American Thyroid Association guidelines, either with molecular testing (MT) or without [standard of care (StC)]. Model endpoints were either benign FNA results or definitive histological diagnosis. RESULTS: Molecular testing added $104 per patient to the overall cost of nodule evaluation (StC $578 vs. MT $682). In this distributed cost model, MT was associated with a decrease in the number of diagnostic lobectomies (9.7% vs. StC 11.6%), whereas initial total thyroidectomy was more frequent (18.2% vs. StC 16.1%). Although MT use added a diagnostic cost of $5031 to each additional indicated total thyroidectomy ($11,383), the cumulative cost was still less than the comparable cost of performing lobectomy ($7684) followed by completion thyroidectomy ($11,954) in the StC pathway, when indicated by histological results. In sensitivity analysis, savings were demonstrated if molecular testing cost was less than $870. CONCLUS...