High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis
Authors' conclusion
Currently, a high rate of unnecessary surgeries is being performed for cytologically indeterminate thyroid nodules. MT was more effective in reducing unnecessary surgeries than current practice, but at a higher cost.
Study context
- Population
- Consecutive Bethesda III or IV thyroid nodules, tertiary endocrine surgery centre in Hong KongFine needle aspiration cytology (FNACs) analysed
- Participants
- 1,957 participants
- Comparison
- Routine MT vs current practice
- Outcome
- Rate of unnecessary surgery without MT and cost-effectiveness of routine MT in avoiding unnecessary surgeries
Methodological detailscost-effectiveness study, decision tree model, public healthcare provider's perspective, single tertiary centre, consecutive nodules, Over a 4-year period, 2157 FNACs performed
- Cost-effectiveness study
- Decision tree model
- Public healthcare provider's perspective
- Single tertiary centre
- Consecutive nodules
- Over a 4-year period, 2157 FNACs performed
Main finding
As reported in the abstract
- Bethesda III or IV among analysed FNACs
- 18.6%
- Indeterminate nodules receiving upfront surgery (current practice)
- 36%
- Malignancy in final pathology after upfront surgery
- 28%
- Unnecessary surgeries in current practice
- 72%
- Unnecessary surgeries reduced by routine MT vs current practice
- 82/year (26% more)
- ICER of routine MT per unnecessary surgery
- Hong Kong dollar (HKD) 49,102 (USD 6314)
Further findings
Sensitivity analysis
- MT price threshold below which routine MT is cost-saving
- HKD 8044 (USD 1031)
- Test cost of MT contributed significantly to ICER
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
High Rates of Unnecessary Surgery for Indeterminate Thyroid Nodules in the Absence of Molecular Test and the Cost-Effectiveness of Utilizing Molecular Test in an Asian Population: A Decision Analysis. Thyroid. Published 21 January 2025. doi:10.
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