Journal article
Cost-effectiveness of routine calcitonin screening and fine-needle aspiration biopsy in preoperative diagnosis of medullary thyroid Cancer in the United States
Oral oncology, Vol.110, pp.104878-104878
11/2020
DOI: 10.1016/j.oraloncology.2020.104878
PMID: 32652480
Abstract
•Fine-needle aspiration biopsy (FNAB) is inadequate for early detection of Medullary Thyroid Carcinoma (MTC).•In this study, routine Calcitonin (Ctn) screening with FNAB was cost-effective compared to FNAB only in all tested scenarios except when cutoff value of 10 pg/ml was applied.•Although, Ctn screening is not perfect in detecting MTC at early stages, it is a cost-effective alternative of discovering MTC after thyroid lobectomy or on follow-up of a thyroid nodule.
examine the cost-effectiveness of routine Calcitonin (Ctn) screening test in the United States.
Markov chain model was developed that compares fine-needle aspiration biopsy (FNAB) with Ctn screening vs. FNAB-only in the evaluation of a thyroid nodule with non-highly suspicious findings. Follow-up time was set as 10 years. Costs and probabilities values were obtained from literature, and National Cancer Database. Cost data is expressed in U.S$ and effectiveness is expressed in Quality-adjusted-life-year (QALY). Incremental cost-effectiveness ratio (ICER) was calculated comparing both study arms.
Routine Ctn screening was cost-effective compared to FNAB-only in all tested categories except when cutoff value of 10 pg/ml was applied. Among the tested categories, the application of universal routine Ctn screening with Ctn value > 50 pg/ml considered a positive test produced the most cost-saving scenario. The final accrued cost at the end of 10 years in the FNAB-only arm was $4238.93 with a final effectiveness of 8.717 QALY. While the final cost in the FNAB-with routine Ctn screening was $4345.04 with a final effectiveness of 8.722 QALY. ICER of routine Ctn screening compared to FNAB-only was $23278.61/QALY (<Willing-To-Pay threshold of $50,000/QALY). Based on sensitivity analyses, Ctn testing is cost-effective if the test cost is less than $236.03.
Routine Ctn screening is a cost-effective strategy in US if the cost is less than $236.03. Although Ctn screening is not perfect in detecting MTC at early stages, it is a cost-effective alternative of discovering MTC after thyroid lobectomy or on follow-up of a thyroid nodule.
Details
- Title: Subtitle
- Cost-effectiveness of routine calcitonin screening and fine-needle aspiration biopsy in preoperative diagnosis of medullary thyroid Cancer in the United States
- Creators
- Zaid Al-Qurayshi - Department of Otolaryngology – Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USAEmad Kandil - Tulane UniversityGregory W Randolph - Massachusetts Eye and Ear Infirmary
- Resource Type
- Journal article
- Publication Details
- Oral oncology, Vol.110, pp.104878-104878
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.oraloncology.2020.104878
- PMID
- 32652480
- ISSN
- 1368-8375
- eISSN
- 1879-0593
- Language
- English
- Date published
- 11/2020
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984702825402771
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