دورية أكاديمية
أعرض في EDS

Cost analysis of reflexive versus selective molecular testing for indeterminate thyroid nodules.

التفاصيل البيبلوغرافية
العنوان: Cost analysis of reflexive versus selective molecular testing for indeterminate thyroid nodules.
المؤلفون: Hu QL; Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: qlhu@mednet.ucla.edu., Schumm MA; Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: https://twitter.com/@MSchumm90., Zanocco KA; Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: https://twitter.com/@KyleZanocco., Yeh MW; Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: https://twitter.com/@michaelyehmd., Livhits MJ; Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: https://twitter.com/@MashaLivhitsMD., Wu JX; Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: https://twitter.com/@JamesWuMD.
المصدر: Surgery [Surgery] 2022 Jan; Vol. 171 (1), pp. 147-154. Date of Electronic Publication: 2021 Jul 17.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE
أسماء مطبوعة: Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
مواضيع طبية MeSH: Decision Support Techniques*, Molecular Diagnostic Techniques/*economics , Thyroid Nodule/*diagnosis , Thyroidectomy/*economics, Biopsy, Fine-Needle ; Clinical Decision-Making/methods ; Cost-Benefit Analysis ; Humans ; Markov Chains ; Models, Economic ; Molecular Diagnostic Techniques/methods ; Molecular Diagnostic Techniques/statistics & numerical data ; Monte Carlo Method ; Thyroid Gland/pathology ; Thyroid Gland/surgery ; Thyroid Neoplasms ; Thyroid Nodule/genetics ; Thyroid Nodule/pathology ; Thyroid Nodule/surgery ; Thyroidectomy/statistics & numerical data ; United States ; Unnecessary Procedures/economics ; Unnecessary Procedures/statistics & numerical data
مستخلص: Background: Molecular testing is now commonly used to refine the diagnosis of indeterminate thyroid nodules. The purpose of this study is to compare the costs of a reflexive molecular testing strategy to a selective testing strategy for indeterminate thyroid nodules.
Methods: A Markov model was constructed to estimate the annual cost of diagnosis and treatment of a real-world cohort of patients with cytologically indeterminate thyroid nodules, comparing a reflexive testing strategy to a selective testing strategy. Model variables were abstracted from institutional clinical trial data, literature review, and the Medicare physician fee schedule.
Results: The average cost per patient in the reflexive testing strategy was $8,045, compared with $6,090 in the selective testing strategy. In 10,000 Monte Carlo simulations, diagnostic thyroid lobectomy for benign nodules was performed in 2,440 patients in the reflexive testing arm, compared with 3,389 patients in the selective testing arm, and unintentional observation for malignant nodules occurred in 479 patients in the reflexive testing arm, compared with 772 patients in the selective testing arm. The cost of molecular testing had the greatest impact on overall costs, with $1,050 representing the cost below which the reflexive testing strategy was cost saving compared with the selective testing strategy.
Conclusion: In this cost-modeling study, reflexive molecular testing for indeterminate thyroid nodules enabled patients to avoid unnecessary thyroid lobectomy at an estimated cost of $20,600 per surgery avoided.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
التعليقات: Comment in: Surgery. 2022 Jan;171(1):153-154. (PMID: 34284896)
تواريخ الأحداث: Date Created: 20210721 Date Completed: 20220218 Latest Revision: 20220218
رمز التحديث: 20231215
DOI: 10.1016/j.surg.2021.04.050
PMID: 34284895
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-7361
DOI:10.1016/j.surg.2021.04.050