title: Cost impact of molecular testing for indeterminate thyroid nodule fine-needle aspiration biopsies.
abstract: BACKGROUND
  Molecular testing of fine-needle aspiration (FNA) results helps diagnose thyroid cancer, although the additional cost of this adjunct has not been studied. We hypothesized that FNA molecular testing of two indeterminate categories (follicular lesion of undetermined significance and follicular/Hürthle cell neoplasm) can be cost saving.
  
  
  METHODS
  For a hypothetical group of euthyroid patients with a 1-cm or larger solitary thyroid nodule, a decision-tree model was constructed to compare the estimated costs of initial evaluation according to the current American Thyroid Association guidelines, either with molecular testing (MT) or without [standard of care (StC)]. Model endpoints were either benign FNA results or definitive histological diagnosis.
  
  
  RESULTS
  Molecular testing added $104 per patient to the overall cost of nodule evaluation (StC $578 vs. MT $682). In this distributed cost model, MT was associated with a decrease in the number of diagnostic lobectomies (9.7% vs. StC 11.6%), whereas initial total thyroidectomy was more frequent (18.2% vs. StC 16.1%). Although MT use added a diagnostic cost of $5031 to each additional indicated total thyroidectomy ($11,383), the cumulative cost was still less than the comparable cost of performing lobectomy ($7684) followed by completion thyroidectomy ($11,954) in the StC pathway, when indicated by histological results. In sensitivity analysis, savings were demonstrated if molecular testing cost was less than $870.
  
  
  CONCLUSIONS
  Molecular testing of cytologically indeterminate FNA results is cost saving predominantly because of reduction in two-stage thyroidectomy. Appropriate use of emerging molecular testing techniques may thus help optimize patient care, improve resource use, and avoid unnecessary operation.
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. yipl@upmc.edu
authors.forename: Linwah
authors.initials: L
authors.lastname: Yip
authors.forename: Coreen
authors.initials: C
authors.lastname: Farris
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kabaker
authors.forename: Steven P
authors.initials: SP
authors.lastname: Hodak
authors.forename: Marina N
authors.initials: MN
authors.lastname: Nikiforova
authors.forename: Kelly L
authors.initials: KL
authors.lastname: McCoy
authors.forename: Michael T
authors.initials: MT
authors.lastname: Stang
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Yuri E
authors.initials: YE
authors.lastname: Nikiforov
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
mesh_terms: D018249:Adenoma, Oxyphilic / Q000191:economics* / Q000473:pathology / Q000601:surgery; D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D011300:Preoperative Care / Q000191:economics; D013964:Thyroid Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000191:economics* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000191:economics / Q000379:methods; D019564:Unnecessary Procedures / Q000191:economics