title: Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance.
abstract: BACKGROUND
  The 2007 National Cancer Institute (NCI) conference on Thyroid Fine-Needle Aspiration (FNA) introduced the category atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS). Repeat FNA in 3 to 6 months was recommended for low-risk patients. Compliance with these recommendations has been suboptimal. We hypothesized that repeat FNA would be more effective than diagnostic lobectomy, with decreased costs and improved rates of cancer detection.
  
  
  METHODS
  Cost-effectiveness analysis was performed in which we compared diagnostic lobectomy with repeat FNA. A Markov model was developed. Outcomes and probabilities were identified from literature review. Third-party payer costs were estimated in 2010 US dollars. Outcomes were weighted by use of the quality-of-life utility factors, yielding quality-adjusted life years (QALYs). Monte Carlo simulation and sensitivity analysis were used to examine the uncertainty of probability, cost, and utility estimates.
  
  
  RESULTS
  The diagnostic lobectomy strategy cost $8,057 and produced 23.99 QALYs. Repeat FNA cost $2,462 and produced 24.05 QALYs. Repeat FNA was dominant until the cost of FNA increased to $6,091. Dominance of the repeat FNA strategy was not sensitive to the cost of operation or the complication rate.
  
  
  CONCLUSIONS
  The NCI recommendations for repeat FNA regarding follow-up of AUS/FLUS results are cost-effective. Improving compliance with these guidelines should lead to less overall costs, greater quality of life, and fewer unnecessary operations.
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Heller
authors.forename: Kyle
authors.initials: K
authors.lastname: Zanocco
authors.forename: Sara
authors.initials: S
authors.lastname: Zydowicz
authors.forename: Dina
authors.initials: D
authors.lastname: Elaraj
authors.forename: Ritu
authors.initials: R
authors.lastname: Nayar
authors.forename: Cord
authors.initials: C
authors.lastname: Sturgeon
mesh_terms: D044963:Biopsy, Fine-Needle / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017721:Hospital Costs; D006801:Humans; D008390:Markov Chains; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D013959:Thyroid Diseases / Q000175:diagnosis / Q000191:economics* / Q000473:pathology* / Q000628:therapy; D013965:Thyroidectomy / Q000191:economics; D014481:United States