{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:55:06Z","timestamp":1785761706254,"version":"3.56.0"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005301","name":"American College of Surgeons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005301","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Autonomously functioning thyroid nodules (AFTN) can be treated with antithyroid drugs, radioactive iodine (RAI), thyroid lobectomy or radiofrequency ablation (RFA). Although surgery is most definitive, some patients require lifelong hormone supplementation. RFA avoids this sequela, but its efficacy depends on nodule size. This study aims to compare the relative cost\u2010effectiveness of RAI, RFA and lobectomy for treatment of AFTNs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A Markov analysis model was created to simulate clinical outcomes, costs and utilities for three AFTN treatments: (1) thyroid lobectomy, (2) RAI, and (3) RFA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>This mathematical model was created using published literature and modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Transition probabilities, utilities and costs were extracted from published literature, Medicare, and RedBook. The willingness to pay threshold was set to $100,000 per quality\u2010adjusted life year. The model simulated 2\u2010year outcomes, reflecting RFA literature. Sensitivity analyses were conducted to account for uncertainty in model variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the base model, RAI dominated both lobectomy and RFA, with lower estimated cost ($2000 vs. $9452 and $10,087) and higher cumulative utility (1.89 vs. 1.82 and 1.78 quality\u2010adjusted life years). One\u2010way sensitivity analyses demonstrated that relative cost\u2010effectiveness between surgery and RFA was driven by the probability of euthyroidism after RFA and hypothyroidism after lobectomy. RFA becomes more cost\u2010effective than surgery if the rate of euthyroidism after ablation is higher than 69% (baseline 54%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on published data, RAI is most cost\u2010effective in treating most AFTN. Surgery is more cost\u2010effective than RFA in most scenarios, but RFA may be more resource\u2010efficient for smaller nodules with a high likelihood of complete treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15140","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T10:34:55Z","timestamp":1727778895000},"page":"91-100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost Effectiveness of Definitive Treatment Strategies for Autonomously Functioning Thyroid Nodules"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4139-3686","authenticated-orcid":false,"given":"Kendyl M.","family":"Carlisle","sequence":"first","affiliation":[{"name":"Department of Surgery University of Maryland Baltimore Baltimore Maryland 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