FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial.
Eur J Nucl Med Mol Imaging
; 49(10): 3452-3469, 2022 08.
Article
em En
| MEDLINE
| ID: mdl-35435497
ABSTRACT
PURPOSE:
To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules.METHODS:
Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account.RESULTS:
The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was - 1000 (95% CI - 2100 to 0) for thyroid nodule-related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was - 4500 (- 9200 to 150) (p = 0.06). Over the modelled lifelong period, the cost difference was - 9900 (- 23,100 to 3200) (p = 0.14). The difference in QALYs was 0.019 (- 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (- 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of 50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty.CONCLUSION:
Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule-related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. TRIAL REGISTRATION NUMBER This trial is registered with ClinicalTrials.gov NCT02208544 (5 August 2014), https//clinicaltrials.gov/ct2/show/NCT02208544 .Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Nódulo da Glândula Tireoide
Tipo de estudo:
Clinical_trials
/
Health_economic_evaluation
Limite:
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article