Cost-Effectiveness of Thyroid Nodule Molecular Testing in Manitoba
4 affiliations
- 1Department of Otolaryngology – Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada
- 2Department of Pathology, University of Manitoba College of Medicine, Winnipeg, MB, Canada
- 3Head and Neck Surgical Oncology, Department of Otolaryngology – Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada
- 4Head and Neck Surgical Oncology, Department of General Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada
Abstract
Objective:: To determine the cost-effectiveness of molecular testing for indeterminate (Bethesda III/IV) thyroid nodules in a real-world, single-payer healthcare system.
Design:: This retrospective population-based cohort study analyzed fine-needle aspiration biopsy (FNAB) and lobectomy data for thyroid nodules in Manitoba, Canada, during 2023. Microcosting was performed to capture surgical, surveillance, molecular testing, and complication costs in 2023 Canadian dollars. Six molecular tests (Afirma, ThyroSeqV3, ThyroidPrint, ThyroSPEC, ThyGeNEXT/ThyraMIR, and mir-THYpe) were evaluated using site-specific malignancy prevalence (21%) and published test statistics.
Setting:: The study was performed within a publicly funded healthcare system.
Participants:: Participants were 18 years and above having undergone FNAB in Manitoba.
Intervention or Exposures:: Three scenarios were identified Current Care, Molecular Testing, and Reference Standard (diagnostic lobectomy) pathways. The total cost per year were compared among scenarios.
Main Outcome Measures:: Cost-utility analyses compared Current Care, Molecular Testing, and Reference Standard pathways. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. A $50 000/QALY willingness-to-pay (WTP) threshold was used to interpret ICERs.
Results:: Among 1486 FNABs performed, 413 were indeterminate nodules, and 149 patients underwent diagnostic lobectomy. The cost of lobectomy was $7542.69 per patient. All molecular testing strategies improved net QALYs and demonstrated ICERs ranging from $9791.03 to $58 749.94 per QALY compared to Current Care. All tests apart from Afirma were cost-effective at the WTP threshold relative to Current Care. Compared to the Reference Standard, all molecular testing strategies were dominant.
Conclusions:: For the investigated Manitoba scenario, molecular testing for indeterminate thyroid nodules can be a cost-effective strategy, possibly reducing unnecessary surgeries while preserving patient outcomes.
Relevance:: This study contributes to the body of evidence suggesting molecular testing is cost-effective and has potential to influence political decisions in health care spending.
Related
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BibTeX
@article{lee2026costeffectiveness,
title = {{Cost-Effectiveness of Thyroid Nodule Molecular Testing in Manitoba}},
author = {Erika Lee and Rana Chakrabarti and Norbert Viallet and Alok Pathak and Suhail Sayed and Paul Kerr and Ciaran Lane},
journal = {Journal of Otolaryngology - Head \& Neck Surgery},
year = {2026},
month = sep,
doi = {10.1177/19160216261479282},
url = {https://doi.org/10.1177/19160216261479282},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost-Effectiveness of Thyroid Nodule Molecular Testing in Manitoba
AU - Erika Lee
AU - Rana Chakrabarti
AU - Norbert Viallet
AU - Alok Pathak
AU - Suhail Sayed
AU - Paul Kerr
AU - Ciaran Lane
PY - 2026
DA - 2026/09/18
JO - Journal of Otolaryngology - Head & Neck Surgery
DO - 10.1177/19160216261479282
UR - https://doi.org/10.1177/19160216261479282
AB - Objective:: To determine the cost-effectiveness of molecular testing for indeterminate (Bethesda III/IV) thyroid nodules in a real-world, single-payer healthcare system. Design:: This retrospective population-based cohort study analyzed fine-needle aspiration biopsy (FNAB) and lobectomy data for thyroid nodules in Manitoba, Canada, during 2023. Microcosting was performed to capture surgical, surveillance, molecular testing, and complication costs in 2023 Canadian dollars. Six molecular tests (Afirma, ThyroSeqV3, ThyroidPrint, ThyroSPEC, ThyGeNEXT/ThyraMIR, and mir-THYpe) were evaluated using site-specific malignancy prevalence (21%) and published test statistics. Setting:: The study was performed within a publicly funded healthcare system. Participants:: Participants were 18 years and above having undergone FNAB in Manitoba. Intervention or Exposures:: Three scenarios were identified Current Care, Molecular Testing, and Reference Standard (diagnostic lobectomy) pathways. The total cost per year were compared among scenarios. Main Outcome Measures:: Cost-utility analyses compared Current Care, Molecular Testing, and Reference Standard pathways. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. A $50 000/QALY willingness-to-pay (WTP) threshold was used to interpret ICERs. Results:: Among 1486 FNABs performed, 413 were indeterminate nodules, and 149 patients underwent diagnostic lobectomy. The cost of lobectomy was $7542.69 per patient. All molecular testing strategies improved net QALYs and demonstrated ICERs ranging from $9791.03 to $58 749.94 per QALY compared to Current Care. All tests apart from Afirma were cost-effective at the WTP threshold relative to Current Care. Compared to the Reference Standard, all molecular testing strategies were dominant. Conclusions:: For the investigated Manitoba scenario, molecular testing for indeterminate thyroid nodules can be a cost-effective strategy, possibly reducing unnecessary surgeries while preserving patient outcomes. Relevance:: This study contributes to the body of evidence suggesting molecular testing is cost-effective and has potential to influence political decisions in health care spending.
SN - 1916-0208
SN - 1916-0216
ER -