Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules
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ORIGINAL ARTICLE
Cost‑effectiveness of fine‑needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules C. K. H. Wong1 · X. Liu2 · B. H. H. Lang2 Received: 6 March 2020 / Accepted: 9 April 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Objectives A trial-based comparison of the use of resources, costs and health utility outcomes of fine-needle aspiration cytology (FNAC), and watchful observation for incidental small ( 1 cm in greatest dimension and high or mediate suspicion sonographic pattern, ≥ 1.5 cm with a sonographic pattern that is low suspicion and ≥ 2.0 cm with a sonographic pattern that is very low suspicion are recommended to fine-needle aspiration [8]. A study of Choong et al. indicated that the routine ultrasound guidance of fine-needle aspiration is not necessary compared with palpation guidance [9]. Whether to use ultrasound-guided FNAC for clinicians remains controversial for patients with incidental thyroid nodules measuring 1.0–2.0 cm and low suspicion. Additionally, many pieces of literature focusing on the diagnostic accuracy, efficacy, and cost of FNAC, comparison of cost and effectiveness between FNAC and observation management for patients with incidental thyroid nodules at 1.0–2.0 cm have been rarely taken into account [10–12]. It is unknown whether US-guided FNAC is cost-effective compared with watchful surveillance on healthcare-related use of resources, costs, and health utility. We hypothesized that despite of the higher cost, USguided FNAC improved health utility and resulted in better patients’ well-being and might prove to be more cost-effective in comparison with watchful observation in the short terms. The aims of this study were to compare the resources use, costs, and health utility associated with FNAC and watchful observation management for patients first presenting small incidental thyroid nodule. The healthcare-related use of resources, costs, and clinical data in both groups were sourced from a 12-month follow-up empirical data from 314 patients in randomized controlled trial (RCT). This trial aimed to generate information about potential resources use, clinical effectiveness, and cost-effectiveness of FNAC managements. Furthermore, the trial-based economic evaluations were undertaken in the Hong Kong’s healthcare provider perspective, which informed the decision-making of whether FNAC was more cost-effective than watchful observation based on the empirical evidence from the RCT.
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Journal of Endocrinological Investigation
Methods This study was a prospective, RCT conducted at endocrinology surgical clinic in Hong Kong SAR, China. All patients included in the study must meet the following criteria: aged 18 years or above, had incidental nodule measurement size of 1.0–2.0 cm in the largest dimension, a low or very low suspicion sonographic pattern, and normal thyroid function. The nodule had to have a low or very low suspicion sonographic pattern (i.e., isoechoic or hyperechoic solid nodule, or partially cystic nodule with ec
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