OBJECTIVES: More than 75% of thyroidectomies performed by fine needle aspiration (FNA) on indeterminate thyroid nodules (ITN) are unnecessary (benign tissues). We aimed to perform a cost-effectiveness analysis of the clinical routine use of FNA + microRNA profiling test (MPT) versus FNA alone on ITN under the perspective of the Brazilian Private Healthcare System (BPHS).

METHODS: A decision tree model was developed. The efficacy outcome was number of total and unnecessary surgeries avoided. For FNA+MPT group, efficacy parameters were retrieved from a real-world multicentric study with 444 patients, which showed the proportion of surgeries performed when MPT is used. For the FNA only group, it was assumed that all patients with ITN would undergo surgery if MPT was not available (ATA and NCCN recommendations). The costs considered were FNA, MPT, thyroidectomy and monitoring costs. In scenario A, MPT cost was set at USD 1,038 and surgery cost at USD 1,953. In scenario B, the cost of Laryngeal Nerve Monitor was added to the surgery cost (+USD 472), and the MPT cost was reduced to USD 943.1 USD=5.3BRL.

RESULTS: The clinical routine use of FNA+MPT reduced the number of total and unnecessary surgeries in 51.5% and 72.4%, respectively, when compared to FNA only. In scenario A, there is an incremental cost of only USD 72 per-patient with the use of FNA+MPT. However, in scenarios B, FNA+MPT dominated FNA: there is a decrease in costs of USD 256 per-patient.

CONCLUSIONS: The clinical routine use of MPT for ITN after FNA avoided 3/4 of unnecessary surgeries and, consequently, all the burden related to surgeries, both for the patient and for the healthcare system. Clinical benefits are accompanied by low increase or even decrease in costs per patient. MPT incorporation to the BPHS should be considered as a complementary tool for patients with ITN.