title: Cost-effectiveness of using a molecular diagnostic test to improve preoperative diagnosis of thyroid cancer.
abstract: 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.
authors.affiliation: Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Najafzadeh
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Marra
authors.forename: Larry D
authors.initials: LD
authors.lastname: Lynd
authors.forename: Sam M
authors.initials: SM
authors.lastname: Wiseman
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle / Q000191:economics* / Q000379:methods*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000191:economics* / Q000379:methods*; D057234:Preoperative Period; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000175:diagnosis*