Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules

J Endocrinol Invest. 2020 Nov;43(11):1645-1654. doi: 10.1007/s40618-020-01254-0. Epub 2020 Apr 19.

Abstract

Objectives: A trial-based comparison of the use of resources, costs and health utility outcomes of fine-needle aspiration cytology (FNAC), and watchful observation for incidental small (< 2 cm) thyroid nodules was performed using data from the randomized controlled trial (RCT).

Methods: Using data from 314 patients, healthcare-related use of resources, costs, health utility, and quality-adjusted life years (QALYs) were estimated at 12 months after first presentation of incidental thyroid nodule(s) on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for FNAC versus watchful management at 12 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data.

Results: FNAC management was associated with greater use of healthcare resources and mean direct healthcare costs per patient (US$542.47 vs US$411.55). Lower mean 12-month QALYs per patient in FNAC was observed in comparison to watchful observation (0.752 versus 0.758). The probability that FNAC management was cost-effective compared with watchful management at a willingness-to-pay threshold of US50,000 per QALY gained was 26.5%.

Conclusion: Based on 12-month data from RCT, watchful observation appeared cost-saving compared to FNAC in patients with incidental thyroid nodules that have a low-suspicion sonographic pattern and measure between 1.0 and 2.0 cm from healthcare provider perspective. CLINICALTRIALS.

Gov identifier: NCT02398721.

Keywords: Cost-effectiveness analysis; Fine-needle aspiration; QALYs; Randomized controlled trial; Thyroid nodule.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Fine-Needle / economics
  • Biopsy, Fine-Needle / statistics & numerical data
  • China / epidemiology
  • Cost-Benefit Analysis
  • Cytodiagnosis / economics*
  • Cytodiagnosis / methods
  • Cytodiagnosis / statistics & numerical data
  • Female
  • Health Care Costs / statistics & numerical data
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Humans
  • Incidental Findings
  • Male
  • Middle Aged
  • Thyroid Nodule / economics
  • Thyroid Nodule / epidemiology
  • Thyroid Nodule / pathology
  • Thyroid Nodule / therapy*
  • Watchful Waiting / economics*
  • Watchful Waiting / statistics & numerical data

Associated data

  • ClinicalTrials.gov/NCT02398721