ArticleSurgery2018
Cost-effectiveness of lobectomy versus genetic testing (Afirma®) for indeterminate thyroid nodules: Considering the costs of surveillance.
Article in Surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Cost Effectiveness of Genomic Medicine in Cancer Control: A Systematic Literature Review.Applied health economics and health policy · 2025Pooled it
- The Diagnostic Performance of Afirma Gene Expression Classifier for the Indeterminate Thyroid Nodules: A Meta-Analysis.BioMed research international · 2019Pooled it
- Molecular Diagnostics and [Thyroid : official journal of the American Thyroid Association · 2024Trial
- FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial.European journal of nuclear medicine and molecular imaging · 2022Trial
- [European journal of nuclear medicine and molecular imaging · 2022Trial
- Molecular Testing for Thyroid Nodules of Indeterminate Cytology: A Health Technology Assessment.Ontario health technology assessment series · 2022Trial
- National Trends in Thyroidectomy and Molecular Diagnostic Utilization: A Medicare Analysis (2016-2023).The Laryngoscope · 2026Article
- The Landmark Series: Testing in Thyroid Nodule Fine Needle Aspiration Cytology.Annals of surgical oncology · 2025Review
- Intelligent diagnosis of thyroid nodules with AI ultrasound assistance and cytology classification.Frontiers in endocrinology · 2025Article
- Deep-Learning-Based Screening and Ancillary Testing for Thyroid Cytopathology.The American journal of pathology · 2023Article
- Recent Advances in the Surgical Management of Thyroid Cancer.Current oncology (Toronto, Ont.) · 2023Review
- Is There a Role for Molecular Testing for Low-Risk Differentiated Thyroid Cancer? A Cost-Effectiveness Analysis.Cancers · 2023Article
- Thyroid nodules: Global, economic, and personal burdens.Frontiers in endocrinology · 2023Review
- Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale · 2022Article
- Health-related quality of life following FDG-PET/CT for cytological indeterminate thyroid nodules.Endocrine connections · 2022Article
- A machine-learning algorithm for distinguishing malignant from benign indeterminate thyroid nodules using ultrasound radiomic features.Journal of medical imaging (Bellingham, Wash.) · 2022Article
- Differentiated Thyroid Cancer: A Health Economic Review.Cancers · 2021Review
- Article
- Selective use of Molecular Testing Based on Sonographic Features of Cytologically Indeterminate Thyroid Nodules: A Decision Analysis.World journal of surgery · 2020Article
- Thyroid Nodule Molecular Testing: Is It Ready for Prime Time?Frontiers in endocrinology · 2020Review
Corrections and comments
- Commented on byDiscussion.2018
Authors and funding
3 authors.
Funding
Abstract
backgroundWe evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance.
methodsWe used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature. Cost estimates were based on Medicare reimbursements with a 3% discount rate for costs and quality-adjusted life-years.
resultsDuring a 5-year period after the diagnosis of indeterminate thyroid nodules, lobectomy was less costly and more effective than Afirma® (lobectomy: $6,100; 4.50 quality-adjusted life- years vs Afirma®: $9,400; 4.47 quality-adjusted life-years). Only in 253 of 10,000 simulations (2.5%) did Afirma® show a net benefit at a cost-effectiveness threshold of $100,000 per quality- adjusted life-years. There was only a 0.3% probability of Afirma® being cost saving and a 14.9% probability of improving quality-adjusted life-years.
conclusionsOur base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules. These results, however, were highly sensitive to estimates of utilities after lobectomy and living under surveillance after Afirma®.
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