Oichman, Maya1; Ronen, Ohad1,2
1 Faculty of Medicine in the Galilee, Bar ilan university, Safed, Israel
2 Depaertment of Otolaryngology – Head and Neck Surgrey, Galilee Medicacl Center, Nahariya ,Israel
Background: Thyroid nodules are the most common endocrine tumor. Suspicious nodules should undergo fine needle aspiration (FNA) biopsy. Up to one third of these FNA’s are reported as having “indeterminate cytology”. These nodules should undergo repeated FNA or diagnostic thyroidectomies, of which approximately three-quarters prove to be histologically benign. The Afirma© gene expression classifier (GEC) is a molecular test that can be used as a “rule out” test to reclassify them as benign, minimizing the number of unnecessary diagnostic surgery. However, its current use routine use is restricted mainly due to its relative out of pocket high cost.
Methods: We evaluated GEC testing on indeterminate thyroid nodules cost effectiveness in Israel, given local medical costs. We then compared the cost effectiveness of current management of indeterminate thyroid nodules versus management using routine GEC testing, calculating a balance price of the test.
Results: Given the current cost of the test and the costs of surgery and FNA biopsy, Afirma© GEC test is not cost effective. With the other costs remaining fixed its cost needs to be reduced to about one half for it to be cost effective.
Discussion & Conclusion: Although the Afirma© GEC test was not found to be cost effective, it should be considered in special cases due to its high negative predictive value and possible value in avoiding unnecessary diagnostic surgery.