Cost-effectiveness of lobectomy versus genetic testing (Afirma®) for indeterminate thyroid nodules: Considering the costs of surveillance.
Surgery
; 163(1): 88-96, 2018 01.
Article
em En
| MEDLINE
| ID: mdl-29128178
ABSTRACT
BACKGROUND:
We evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance.METHODS:
We used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature. Cost estimates were based on Medicare reimbursements with a 3% discount rate for costs and quality-adjusted life-years.RESULTS:
During a 5-year period after the diagnosis of indeterminate thyroid nodules, lobectomy was less costly and more effective than Afirma® (lobectomy $6,100; 4.50 quality-adjusted life- years vs Afirma® $9,400; 4.47 quality-adjusted life-years). Only in 253 of 10,000 simulations (2.5%) did Afirma® show a net benefit at a cost-effectiveness threshold of $100,000 per quality- adjusted life-years. There was only a 0.3% probability of Afirma® being cost saving and a 14.9% probability of improving quality-adjusted life-years.CONCLUSIONS:
Our base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules. These results, however, were highly sensitive to estimates of utilities after lobectomy and living under surveillance after Afirma®.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
Base de dados:
MEDLINE
Assunto principal:
Glândula Tireoide
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Neoplasias da Glândula Tireoide
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Testes Genéticos
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Nódulo da Glândula Tireoide
Tipo de estudo:
Health_economic_evaluation
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Prognostic_studies
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Screening_studies
Aspecto:
Patient_preference
Limite:
Adult
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Female
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Humans
Idioma:
En
Revista:
Surgery
Ano de publicação:
2018
Tipo de documento:
Article