Cost-Effectiveness of Diagnostic Lobectomy Versus Observation for Thyroid Nodules Greater than 4 cm.

Cost-Effectiveness of Diagnostic Lobectomy Versus Observation for Thyroid Nodules Greater than 4 cm.

Thyroid. 2015 Dec 30;

Authors: Lee L, Mitmaker EJ, Chabot JA, Lee JA, Kuo JH

Abstract
BACKGROUND: The management of thyroid nodules >4 cm with benign cytology after fine-needle aspiration (FNA) is controversial. FNA is associated with a high false-negative rate in this setting and may result in a delayed diagnosis and management of thyroid cancer. However, the majority of these nodules are benign. Therefore the objective was to determine the cost-utility of observation versus surgical management for thyroid nodules >4 cm with benign cytology after FNA.
METHODS: A microsimulation model comparing routine thyroid lobectomy versus observation for low-risk patients with >4cm thyroid nodules with benign FNA cytology was constructed. Costs, quality-adjusted life years (QALYs), and life-years gained were calculated over a lifetime time horizon from a US Medicare perspective.
RESULTS: The proportion of patients undergoing thyroid lobectomy for benign final pathology was 40% in the observation strategy versus 66% in the surgical strategy (p<0.001). Overall, the surgical strategy was associated with higher lifetime costs compared to the observation strategy (incremental difference: +12992 US$; 95% CI 13042, 13524), but also more QALYs (+0.12 QALYs; 95% CI 0.02, 0.24) and longer life expectancy (+1.67 years; 95% CI 1.00, 2.41). Incremental lifetime costs were lower for patients <55 years versus those >=55 years (+11181 vs +14811, p<0.001). The probability of cost-effectiveness of the surgical strategy was 49% at a $100k/QALY threshold or 65% at a $100k/life-year gained threshold.
CONCLUSIONS: Routine thyroid lobectomy is associated with improved outcomes at an acceptable cost compared to observation for thyroid nodules >4cm with benign cytology after FNA. Surgical resection may be a cost-effective strategy to rule out malignancy in these nodules.

PMID: 26715288 [PubMed - as supplied by publisher]

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