The cost-effectiveness of iodine 131 scintigraphy, ultrasonography, and fine-needle aspiration biopsy in the initial diagnosis of solitary thyroid nodules.
OBJECTIVE
To compare the cost-effectiveness of fine-needle aspiration biopsy, iodine 131 scintigraphy, and ultrasonography for the initial diagnostic workup of a solitary palpable thyroid nodule.


METHODS
A deterministic cost-effectiveness analysis was conducted using a decision tree to model the diagnostic strategies.


METHODS
A single, mid-Atlantic academic medical center.


METHODS
Expected costs, expected number of cases correctly diagnosed, and incremental cost per additional case correctly diagnosed.


RESULTS
Relative to the routine use of fine-needle aspiration biopsy, the incremental cost per case correctly diagnosed is 24,554 dollars for the iodine 131 scintigraphy strategy and 1212 dollars for the ultrasound strategy.


CONCLUSIONS
A diagnostic strategy using initial fine-needle aspiration biopsy for palpable thyroid nodules was found to be cost-effective compared with the other approaches as long as a payor's willingness to pay for an additional correct diagnosis is less than 1212 dollars. Prospective studies are needed to validate these finding in clinical practice.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, USA.
Ayesha N
AN
Khalid
Christopher S
CS
Hollenbeak
Sadeq A
SA
Quraishi
Chris Y
CY
Fan
Brendan C
BC
Stack
D001707:Biopsy, Needle / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D007457:Iodine Radioisotopes / Q000191:economics; D011877:Radionuclide Imaging; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics; D014463:Ultrasonography; D014481:United States
D007457:Iodine Radioisotopes