title: BRAF mutation in papillary thyroid cancer: A cost-utility analysis of preoperative testing.
abstract: BACKGROUND
  Papillary thyroid carcinoma (PTC) with BRAF mutation carries a poorer prognosis. Prophylactic central neck dissection (CND) reduces locoregional recurrences, and we hypothesize that initial total thyroidectomy (TT) with CND in patients with BRAF-mutated PTC is cost effective.
  
  
  METHODS
  This cost-utility analysis is based on a hypothetical cohort of 40-year-old women with small PTC [2 cm, confined to the thyroid, node(-)]. We compared preoperative BRAF testing and TT+CND if BRAF-mutated or TT alone if BRAF-wild type, versus no testing with TT. This analysis took into account treatment costs and opportunity losses. Key variables were subjected to sensitivity analysis.
  
  
  RESULTS
  Both approaches produced comparable outcomes, with costs of not testing being lower (-$801.51/patient). Preoperative BRAF testing carried an excess expense of $33.96 per quality-adjusted life-year per patient. Sensitivity analyses revealed that when BRAF positivity in the testing population decreases to 30%, or if the overall noncervical recurrence in the population increases above 11.9%, preoperative BRAF testing becomes the more cost-effective strategy.
  
  
  CONCLUSIONS
  Outcomes with or without preoperative BRAF testing are comparable, with no testing being the slightly more cost-effective strategy. Although preoperative BRAF testing helps to identify patients with higher recurrence rates, implementing a more aggressive initial operation does not seem to offer a cost advantage.
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA.
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA. Electronic address: bpalmer@alamedahealthsystem.org.
authors.forename: Barnard J A
authors.initials: BJ
authors.lastname: Palmer
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA.
authors.forename: Arturo
authors.initials: A
authors.lastname: Garcia
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA.
authors.forename: Vincent E
authors.initials: VE
authors.lastname: Chong
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA.
authors.forename: Terrence H
authors.initials: TH
authors.lastname: Liu
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000191:economics / Q000235:genetics* / Q000601:surgery; D002291:Carcinoma, Papillary; D003362:Cost-Benefit Analysis; D004252:DNA Mutational Analysis / Q000191:economics; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D008962:Models, Theoretical; D037981:Neck Dissection / Q000191:economics* / Q000379:methods; D011300:Preoperative Care / Q000191:economics; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000191:economics / Q000235:genetics* / Q000601:surgery; D013965:Thyroidectomy / Q000191:economics* / Q000379:methods
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf