Cost-effectiveness of routine calcitonin screening and fine-needle aspiration biopsy in preoperative diagnosis of medullary thyroid Cancer in the United States. (November 2020)

• Record Type: Journal Article
• Authors: Al-Qurayshi, Zaid; Kandil, Emad; Randolph, Gregory W
• Is Part Of: Oral oncology. Volume 110(2020)
• Publication Date: 2020-11
• Subjects: Cost-effectiveness analysis -- Thyroid nodule -- Medullary thyroid carcinoma -- Serum calcitonin -- Screening test -- Fine-needle aspiration biopsy; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2020.104878
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: 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. Abstract: Objectives: examine the cost-effectiveness of routine Calcitonin (Ctn) screening test in the United States. Materials and methods: 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. Results: 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. Conclusions: 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.