High-Suspicion Subcentimeter Thyroid Nodules: Cost Effectiveness of Active Surveillance versus Fine Needle Aspiration.

Autor:	Woon TK; Diagnostic Radiology, Singapore Health Services (SingHealth), Singapore. Electronic address: tiankai.woon@mohh.com.sg., Zhou K; Health Services and Systems Research, Duke-NUS Medical School, Singapore., Tan BS; Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore., Matchar DB; Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Medicine (General Internal Medicine), Duke University, Durham, North Carolina.
Jazyk:	angličtina
Zdroj:	Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2023 Feb; Vol. 34 (2), pp. 173-181. Date of Electronic Publication: 2022 Nov 16.
DOI:	10.1016/j.jvir.2022.11.005
Abstrakt:	Purpose: To compare the cost-benefit of active surveillance (AS) against immediate fine needle aspiration (FNA) of sonographically suspicious subcentimeter thyroid nodules. Materials and Methods: A Markov model was constructed to compare the cost-benefit of 3 strategies from the point of discovery until death: (a) Surveillance of all nodules, (b) Surveillance of nodules with positive cytology, and (c) Surgery of nodules with positive cytology. The reference case was a 40-year-old woman with a sonographically suspicious subcentimeter thyroid nodule. Transition probabilities, costs, and health state utilities were derived from the literature. Sensitivity analyses were performed to evaluate model uncertainty. Willingness-to-pay threshold was set at $100,000/quality-adjusted life year. Results: Surveillance of nodules with positive cytology dominated in the reference scenario and was cost-beneficial over Surveillance of all nodules, independent of the utility of AS. Surveillance of all nodules was cost-beneficial only at a life expectancy of <2.6 years or surveillance duration of <4 years. Conclusions: While current guidelines recommend AS of sonographically suspicious subcentimeter nodules, the results of this study suggest that immediate FNA (Surveillance of nodules with positive cytology) is more cost-beneficial than AS (Surveillance of all nodules). Patients with positive cytology on FNA may subsequently opt for AS (Surveillance of nodules with positive cytology) or surgery (Surgery of nodules with positive cytology) according to their level of comfort (ie, utility) with AS. (Copyright © 2022 SIR. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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