{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:54:23Z","timestamp":1790934863295,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This systematic review tests the hypothesis that radiofrequency ablation (RFA) for benign non\u2010functioning thyroid nodules is associated with favourable cost\u2010effectiveness compared with surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A systematic literature search of multiple databases (Embase, Medline, Web of Science, and Cochrane Central) was conducted through 16 May 2025, with no restrictions on publication date or language. Full economic evaluations comparing RFA with alternative management strategies were included in the primary synthesis. Secondary narrative synthesis included studies reporting cost data without formal cost\u2010effectiveness modelling. All costs were converted to 2021 US dollars to enable cross\u2010study comparability. Incremental cost\u2010effectiveness ratios (ICERs), net monetary benefit (NMB), and net health benefit (NHB) were calculated where data allowed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen studies met the inclusion criteria: 3 full economic evaluations and 10 descriptive cost studies. All compared RFA to surgery. In the primary synthesis, two studies reported ICERs for RFA versus surgery, which ranged from \u2013$14\u2009994 (reflecting a lower cost and greater effectiveness for RFA) to $98\u2009858 per QALY gained, with substantial variation in model design and assumptions. Post hoc estimates of NMB and NHB generally favoured RFA at $50\u2009000 and $100\u2009000 willingness\u2010to\u2010pay thresholds. In the narrative synthesis, 8 of 10 studies reported lower total costs for RFA (median: $2499) compared to surgery (median: $3579). Methodological heterogeneity limited comparability. Overall certainty of economic evidence was rated as low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RFA may be a cost\u2010effective alternative to surgery for benign thyroid nodules, but current economic evidence is limited and of low certainty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/coa.70150","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:54:23Z","timestamp":1785718463000},"page":"805-818","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of Radiofrequency Ablation for Benign Non\u2010Functioning Thyroid Nodules: A Systematic Review"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4745-7978","authenticated-orcid":false,"given":"Sam P. J.","family":"van Dijk","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology and Gastrointestinal Surgery Academic Center for Thyroid Disease, Erasmus MC Cancer Institute  Rotterdam the Netherlands"},{"name":"Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M. K.","family":"Blanco","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7077-3442","authenticated-orcid":false,"given":"Ali","family":"Akhavan","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Sloan School of Management, Massachusetts Institute of Technology  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6492-4953","authenticated-orcid":false,"given":"Jessica Liu","family":"McMullin","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Scott","family":"Gazelle","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"MGH Institute for Technology Assessment, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6769-2732","authenticated-orcid":false,"given":"Mohammad S.","family":"Jalali","sequence":"additional","affiliation":[{"name":"Sloan School of Management, Massachusetts Institute of Technology  Cambridge Massachusetts USA"},{"name":"MGH Institute for Technology Assessment, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-4430","authenticated-orcid":false,"given":"Jagpreet","family":"Chhatwal","sequence":"additional","affiliation":[{"name":"MGH Institute for Technology Assessment, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4324-9530","authenticated-orcid":false,"given":"Yinin","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery University of Maryland Baltimore  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9365-4892","authenticated-orcid":false,"given":"Tessa M.","family":"van Ginhoven","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology and Gastrointestinal Surgery Academic Center for Thyroid Disease, Erasmus MC Cancer Institute  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajshri M.","family":"Gartland","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"MGH Institute for Technology Assessment, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102362.2009.02162.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2015.273"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020\u2010016\u20100967\u20109"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2022.0621"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.tvir.2013.08.002"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje\u201018\u20100685"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2018.19.4.632"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010024\u201010881\u20107"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.2174\/1871530323666230201104112"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000508484"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2333032052"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.14366\/usg.21117"},{"key":"e_1_2_12_14_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 65","author":"Aluko P. G. E.","year":"2024"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.01.002"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010020\u201001542\u2010z"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.5195\/jmla.2018.283"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1586\/14737167.2015.1103185"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462305050324"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654\u2010010\u20109491\u2010z"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916\u2010021\u201002204\u20100"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2012.04.012"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2022.08.048"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020\u2010023\u201003403\u2010w"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep37838"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.360"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/934595"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4276"},{"issue":"2","key":"e_1_2_12_30_1","first-page":"718","article-title":"Ultrasound\u2010Guided Radiofrequency Ablation Versus Total Thyroidectomy for Benign Solitary Thyroid Nodules by Fine\u2010Needle Aspiration Cytology","volume":"40","author":"Elhefny A. M. M.","year":"2021","journal-title":"Egyptian Journal of Surgery"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000001201"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.1276"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27213"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.20945\/2359\u20103997000000411"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/02656736.2021.1873429"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7890"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2020.35.2.339"},{"key":"e_1_2_12_38_1","unstructured":"Association. AM \u201cCPT (Current Procedural Terminology)\u201daccessed Jun 5 2025 https:\/\/www.ama\u2010assn.org\/practice\u2010management\/cpt."},{"key":"e_1_2_12_39_1","unstructured":"(CMS) CfMMS \u201cMedicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B Payment Policies\u201daccessed Jun 5 2025 https:\/\/www.federalregister.gov\/documents\/2024\/07\/31\/2024\u201014828\/medicare\u2010and\u2010medicaid\u2010programs\u2010cy\u20102025\u2010payment\u2010policies\u2010under\u2010the\u2010physician\u2010fee\u2010schedule\u2010and\u2010other."},{"key":"e_1_2_12_40_1","unstructured":"Aetna \u201cRadiofrequency Ablation of Thyroid Nodules. Clinical Policy Bulletin #0492\u201daccessed Jun 5 2025 https:\/\/www.aetna.com\/cpb\/medical\/data\/400_499\/0492.html."},{"key":"e_1_2_12_41_1","unstructured":"Cigna \u201cRadiofrequency Ablation for Benign and Malignant Thyroid Nodules. Medical Coverage Policy #0575\u201daccessed Jun 5 2025 https:\/\/static.cigna.com\/assets\/chcp\/pdf\/coveragePolicies\/medical\/mm_0575_coveragepositioncriteria_rfa_thyroid.pdf."},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2020.0038"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40271\u2010017\u20100220\u20105"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.15140"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70150","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.70150","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70150","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:09:11Z","timestamp":1790932151000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.70150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/coa.70150"],"URL":"https:\/\/doi.org\/10.1111\/coa.70150","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"value":"1749-4478","type":"print"},{"value":"1749-4486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]},"assertion":[{"value":"2026-01-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}