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Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules

  • Original Article
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Abstract

Objectives

A trial-based comparison of the use of resources, costs and health utility outcomes of fine-needle aspiration cytology (FNAC), and watchful observation for incidental small (< 2 cm) thyroid nodules was performed using data from the randomized controlled trial (RCT).

Methods

Using data from 314 patients, healthcare-related use of resources, costs, health utility, and quality-adjusted life years (QALYs) were estimated at 12 months after first presentation of incidental thyroid nodule(s) on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for FNAC versus watchful management at 12 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data.

Results

FNAC management was associated with greater use of healthcare resources and mean direct healthcare costs per patient (US$542.47 vs US$411.55). Lower mean 12-month QALYs per patient in FNAC was observed in comparison to watchful observation (0.752 versus 0.758). The probability that FNAC management was cost-effective compared with watchful management at a willingness-to-pay threshold of US50,000 per QALY gained was 26.5%.

Conclusion

Based on 12-month data from RCT, watchful observation appeared cost-saving compared to FNAC in patients with incidental thyroid nodules that have a low-suspicion sonographic pattern and measure between 1.0 and 2.0 cm from healthcare provider perspective.

ClinicalTrials.gov Identifier

NCT02398721.

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Abbreviations

FNAC:

Fine-needle aspiration cytology

RCT:

Randomized controlled trial

QALYs:

Quality-adjusted life years

US:

Ultrasonography

ATA:

American Thyroid Association

HRQOL:

Health-related quality of life

ROC:

Receiver operating characteristic curve

ICER:

Incremental cost-effectiveness ratio

CEAC:

Cost-effectiveness acceptability curve

WS:

Watchful surveillance

References

  1. Hegedus L (2004) Clinical practice. The thyroid nodule. N Engl J Med 351:1764–1771

    Article  Google Scholar 

  2. Yoon DY, Chang SK, Choi CS, Yun EJ, Seo YL et al (2008) The prevalence and significance of incidental thyroid nodules identified on computed tomography. J Comput Assist Tomogr 32:810–815

    Article  Google Scholar 

  3. Guth S, Theune U, Aberle J, Galach A, Bamberger CM (2009) Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 39:699–706

    Article  CAS  Google Scholar 

  4. Agrawal S (1995) Diagnostic accuracy and role of fine needle aspiration cytology in management of thyroid nodules. J Surg Oncol 58:168–172

    Article  CAS  Google Scholar 

  5. Gupta M, Gupta S, Gupta VB (2010) Correlation of fine needle aspiration cytology with histopathology in the diagnosis of solitary thyroid nodule. J Throid Res 20:20

    Google Scholar 

  6. Bagga PK, Mahajan NC (2010) Fine needle aspiration cytology of thyroid swellings: how useful and accurate is it? Indian J Cancer 47:437–442

    Article  CAS  Google Scholar 

  7. Ha EJ, Na DG, Baek JH, Sung JY, Kim JH et al (2018) US fine-needle aspiration biopsy for thyroid malignancy: diagnostic performance of seven society guidelines applied to 2000 thyroid nodules. Radiology 287:893–900

    Article  Google Scholar 

  8. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ et al (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133

    Article  Google Scholar 

  9. Choong KC, Khiyami A, Tamarkin SW, McHenry CR (2018) Fine-needle aspiration biopsy of thyroid nodules: is routine ultrasound-guidance necessary? Surgery 164:789–794

    Article  Google Scholar 

  10. Ikram M, Hyder J, Muzaffar S, Hasan SH (1999) Fine needle aspiration cytology (FNAC) in the management of thyroid pathology—the Aga Khan University Hospital experience. J Pak Med Assoc 49:133–135

    CAS  PubMed  Google Scholar 

  11. Muratli A, Erdogan N, Sevim S, Unal I, Akyuz S (2014) Diagnostic efficacy and importance of fine-needle aspiration cytology of thyroid nodules. J Cytol 31:73–78

    Article  Google Scholar 

  12. Hamberger B, Gharib H, Melton LJ 3rd, Goellner JR, Zinsmeister AR (1982) Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care. Am J Med 73:381–384

    Article  CAS  Google Scholar 

  13. Wong CKH, Lang BHH (2020) A randomized trial comparing health-related quality-of-life and utility measures between routine fine-needle aspiration cytology (FNAC) and surveillance alone in patients with thyroid incidentaloma measuring 1–2 cm. Endocrine 67:397–405

    Article  CAS  Google Scholar 

  14. Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I et al (2003) Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol 29:203–206

    Article  Google Scholar 

  15. Wong CKH, Lang BHH, Yu HMS, Lam CLK (2017) EQ-5D-5L and SF-6D utility measures in symptomatic benign thyroid nodules: acceptability and psychometric evaluation. Patient 10:447–454

    Article  Google Scholar 

  16. Hospital. Authority, List of private services—operations 2019. https://www3.ha.org.hk/fnc/Operations.aspx?lang=ENG

  17. Hospital. Authority, Hospital Authority Ordinance (Chapter 113): revisions to list of charges, G.N. 3884.2017

  18. Walters SJ, Brazier JE (2005) Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res 14:1523–1532

    Article  Google Scholar 

  19. Wong CKH, Lam ETP, Lam CLK (2013) Comparison of direct-measured and derived short form six dimensions (SF-6D) health preference values among chronic hepatitis B patients. Qual Life Res 22:2973–2981

    Article  Google Scholar 

  20. Lothgren M, Zethraeus N (2000) Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Econ 9:623–630

    Article  CAS  Google Scholar 

  21. Briggs AH, Wonderling DE, Mooney CZ (1997) Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 6:327–340

    Article  CAS  Google Scholar 

  22. Woods B, Revill P, Sculpher M, Claxton K (2016) Country-level cost-effectiveness thresholds: initial estimates and the need for further research. Value Health 19:929–935

    Article  Google Scholar 

  23. Accurso A, Rocco N, Palumbo A, Feleppa C (2009) Usefulness of ultrasound-guided fine-needle aspiration cytology in the diagnosis of non-palpable small thyroid nodules: our growing experience. J Endocrinol Invest 32:156–159

    Article  CAS  Google Scholar 

  24. Hunink MG, Bult JR, de Vries J, Weinstein MC (1998) Uncertainty in decision models analyzing cost-effectiveness: the joint distribution of incremental costs and effectiveness evaluated with a nonparametric bootstrap method. Med Decis Mak 18:337–346

    Article  CAS  Google Scholar 

  25. Cohen DJ, Reynolds MR (2008) Interpreting the results of cost-effectiveness studies. J Am Coll Cardiol 52:2119–2126

    Article  Google Scholar 

  26. Leboulleux S, Borget I, Labro S, Bidault S, Vielh P et al (2013) Frequency and intensity of pain related to thyroid nodule fine-needle aspiration cytology. Thyroid 23:1113–1118

    Article  Google Scholar 

  27. Leenhardt L, Hejblum G, Franc B, Fediaevsky LD, Delbot T et al (1999) Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab 84:24–28

    Article  CAS  Google Scholar 

  28. Iyer NG, Shaha AR (2010) Management of thyroid nodules and surgery for differentiated thyroid cancer. Clin Oncol (R Coll Radiol) 22:405–412

    Article  CAS  Google Scholar 

  29. Popoveniuc G, Jonklaas J (2012) Thyroid nodules. Med Clin N Am 96:329–349

    Article  CAS  Google Scholar 

  30. Giles WH, Maclellan RA, Gawande AA, Ruan DT, Alexander EK et al (2015) False negative cytology in large thyroid nodules. Ann Surg Oncol 22:152–157

    Article  Google Scholar 

  31. Ahn HS, Na DG, Baek JH, Sung JY, Kim JH (2019) False negative rate of fine-needle aspiration in thyroid nodules: impact of nodule size and ultrasound pattern. Head Neck 41:967–973

    Article  Google Scholar 

  32. Raj SD, Ram R, Sabbag DJ, Sultenfuss MA, Matejowsky R (2019) Thyroid fine needle aspiration: successful prospective implementation of strategies to eliminate unnecessary biopsy in the veteran population. Curr Probl Diagn Radiol 48:127–131

    Article  Google Scholar 

  33. Paschke R, Cantara S, Crescenzi A, Jarzab B, Musholt TJ et al (2017) European Thyroid Association Guidelines regarding thyroid nodule molecular fine-needle aspiration cytology diagnostics. Eur Thyroid J 6:115–129

    Article  Google Scholar 

  34. Muzza M, Colombo C, Pogliaghi G, Karapanou O, Fugazzola L (2019) Molecular markers for the classification of cytologically indeterminate thyroid nodules. J Endocrinol Invest 20:20

    Google Scholar 

  35. Cozzolino A, Pozza C, Pofi R, Sbardella E, Faggiano A et al (2020) Predictors of malignancy in high-risk indeterminate (TIR3B) cytopathology thyroid nodules. J Endocrinol Invest 20:20

    Google Scholar 

  36. Saravana-Bawan B, Bajwa A, Paterson J, McMullen T (2020) Active surveillance of low-risk papillary thyroid cancer: a meta-analysis. Surgery 167:46–55

    Article  Google Scholar 

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Funding

This study has been funded by the Health and Medical Research Fund, Food and Health Bureau, HKSAR (Ref. no 12132941).

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Authors and Affiliations

  1. Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

    C. K. H. Wong

  2. Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China

    X. Liu & B. H. H. Lang

Authors
  1. C. K. H. Wong
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  2. X. Liu
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  3. B. H. H. Lang
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Corresponding author

Correspondence to C. K. H. Wong.

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Conflict of interest

Author Carlos KH Wong declares that he has no conflict of interest. Author Xiaodong Liu declares that she has no conflict of interest. Author Brian HH Lang declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wong, C.K.H., Liu, X. & Lang, B.H.H. Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules. J Endocrinol Invest 43, 1645–1654 (2020). https://doi.org/10.1007/s40618-020-01254-0

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  • DOI: https://doi.org/10.1007/s40618-020-01254-0

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