FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial

• Published in: European journal of nuclear medicine and molecular imaging 2022-08, Vol.49 (10), p.3452-3469
• Main Authors: de Koster, Elizabeth J., Vriens, Dennis, van Aken, Maarten O., Dijkhorst-Oei, Lioe-Ting, Oyen, Wim J. G., Peeters, Robin P., Schepers, Abbey, de Geus-Oei, Lioe-Fee, van den Hout, Wilbert B.
• Format: Article
• Language: English
• Subjects: Cardiology; Computed tomography; Cost analysis; Cytology; Diagnostic systems; Endocrinology; Fluorine isotopes; Imaging; Markov chains; Medicine; Medicine & Public Health; Nodules; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Positron emission tomography; Quality of life; Radiology; Surgery; Thyroid; Thyroid cancer; Thyroid gland
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-022-05794-w

Purpose To evaluate cost-effectiveness of an [ 18 F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [ 18 F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules. Methods Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [ 18 F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. Results The observed 1-year cost difference of [ 18 F]FDG-PET/CT as compared to diagnostic surgery was − €1000 (95% CI: − €2100 to €0) for thyroid nodule–related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was − €4500 (− €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was − €9900 (− €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (− 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (− 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [ 18 F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty. Conclusion Following the observed reduction in diagnostic surgery, an [ 18 F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule–related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544 .