title: Fine-needle aspiration biopsy versus ultrasound-guided fine-needle aspiration biopsy: cost-effectiveness as a frontline diagnostic modality for solitary thyroid nodules.
abstract: BACKGROUND
  Ultrasound-guided fine-needle aspiration biopsy (ultrasound-guided FNAB) is considered the diagnostic test of choice when a fine-needle aspiration biopsy (FNAB) returns an inconclusive diagnosis because of cytologic ambiguity or paucity of specimen.
  
  
  METHODS
  Cost-effectiveness analysis utilizing a decision tree was used to model the diagnostic strategies. The decision analysis model was parameterized using costs from a large, academic medical center and probabilities from existing literature. Outcomes included the incremental cost per additional case correctly diagnosed.
  
  
  RESULTS
  All data are reported as frontline ultrasound-guided FNAB strategy versus FNAB strategy-expected cost: $1329 versus $1312; expected number of cases correctly diagnosed (per 1000 biopsies): 980 versus 920; incremental cost per additional correctly diagnosed case: $289.
  
  
  CONCLUSIONS
  The use of ultrasound-guided FNAB as the initial modality for tissue biopsy of a thyroid nodule is more effective than traditional FNAB at an additional cost of $289 per additional correct diagnosis.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Ayesha N
authors.initials: AN
authors.lastname: Khalid
authors.forename: Sadeq A
authors.initials: SA
authors.lastname: Quraishi
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Stack
mesh_terms: D000465:Algorithms; D001499:Bayes Theorem; D044963:Biopsy, Fine-Needle / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000473:pathology; D016606:Thyroid Nodule / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000191:economics*