362 chapter 6 Abstract Purpose: To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]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 [18F]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 [18F]FDG-PET/CT as compared to diagnostic surgery was -€1,000 (95% CI: -€2,100 to €0) for thyroid nodule-related care (p=0.06). From the broader societal perspective, the 1-year difference in total societal costs was -€4,500 (-€9,200 to €150) (p=0.06). Over the modelled lifelong period, the cost difference was -€9,900 (-€23,100 to €3,200) (p=0.14). The difference in QALYs was 0.019 (-0.045 to 0.083) at one 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 [18F]FDGPET/CT-driven work-up was the cost-effective strategy with 84% certainty. Conclusion: Following the observed reduction in diagnostic surgery, an [18F]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.
RkJQdWJsaXNoZXIy MTk4NDMw