Cost-Effectiveness of Using a Molecular Diagnostic Test to Improve Preoperative Diagnosis of Thyroid Cancer

Dec 1, 2012, 00:00
10.1016/j.jval.2012.06.017
https://www.valueinhealthjournal.com/article/S1098-3015(12)01660-9/fulltext
Title : Cost-Effectiveness of Using a Molecular Diagnostic Test to Improve Preoperative Diagnosis of Thyroid Cancer
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(12)01660-9&doi=10.1016/j.jval.2012.06.017
First page : 1005
Section Title : Economic Evaluation
Open access? : No
Section Order : 1

Objective

Fine-needle aspiration biopsy (FNAB) is a safe and inexpensive diagnostic procedure for evaluating thyroid nodules.Up to 25% of the results from an FNAB, however, may not be diagnostic or may be indeterminate, leading to a subsequent diagnostic thyroid surgery. A new molecularly based diagnostic test could potentially reduce indeterminate cytological results and, with high accuracy, provide a definitive diagnosis for cancer in thyroid nodules. The aim of the study was to estimate the cost-effectiveness of utilizing a molecular diagnostic (DX) test as an adjunct to FNAB, compared with NoDX, to improve the preoperative diagnosis of thyroid nodules.

Methods

We constructed a patient-level simulation model to estimate the clinical and economic outcomes of using a DX test compared with current practice (NoDX) for the diagnosis of thyroid nodules. By using a cost-effectiveness framework, we measured incremental clinical benefits in terms of quality-adjusted life-years and incremental costs over a 10-year time horizon.

Results

Assuming 95% sensitivity and specificity of the Dx test when used as an adjunct to FNAB, the utilization of the DX test resulted in a gain of 0.046 quality-adjusted life-years (95% confidence interval 0.019–0.078) and a saving of $1087 (95% confidence interval $691–$1533) in direct costs per patient. If the cost of the Dx test is less than $1087 per test, we expect to save quality-adjusted life-years and reduce costs when it is utilized. Sensitivity of the DX test, compared with specificity, had a larger influence on the overall outcomes.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Diabetes/Endocrine/Metabolic Disorders
  • Diagnostics & Imaging
  • Economic Evaluation
  • Medical Technologies
  • Specific Diseases & Conditions
Tags :
  • cost-effectiveness
  • fine needle aspiration biopsy
  • gene expression
  • molecular diagnostic test
  • The Bethesta System for Reporting Thyroid Cytopathology (TBSRTC)
  • thyroid cancer
Regions :
  • North America
ViH Article Tags :