{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:06:05Z","timestamp":1789977965171,"version":"4.0.1"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine the cost-effectiveness of molecular testing for indeterminate (Bethesda III\/IV) thyroid nodules in a real-world, single-payer healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>The study was performed within a publicly funded healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>Participants were 18 years and above having undergone FNAB in Manitoba.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention or Exposures:<\/jats:title>\n                    <jats:p>Three scenarios were identified Current Care, Molecular Testing, and Reference Standard (diagnostic lobectomy) pathways. The total cost per year were compared among scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216261479282","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T04:42:57Z","timestamp":1789792977000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of Thyroid Nodule Molecular Testing in Manitoba"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6310-0197","authenticated-orcid":false,"given":"Erika","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Viallet","sequence":"additional","affiliation":[{"name":"Head and Neck Surgical Oncology, Department of Otolaryngology \u2013 Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok","family":"Pathak","sequence":"additional","affiliation":[{"name":"Head and Neck Surgical Oncology, Department of General Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhail","family":"Sayed","sequence":"additional","affiliation":[{"name":"Head and Neck Surgical Oncology, Department of Otolaryngology \u2013 Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kerr","sequence":"additional","affiliation":[{"name":"Head and Neck Surgical Oncology, Department of Otolaryngology \u2013 Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciaran","family":"Lane","sequence":"additional","affiliation":[{"name":"Head and Neck Surgical Oncology, Department of Otolaryngology \u2013 Head and Neck Surgery, University of Manitoba College of Medicine, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"1869","volume-title":"Cummings Otolaryngology: Head and Neck Surgery","author":"Ahmad FI","year":"2020","unstructured":"Ahmad FI, Zafereo ME, Lai SY. Management of thyroid neoplasms. In: Flint PW, Haughey BH, Lund VJ, et al. eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed., Vol. 122; 2020:1869-1898. Elsevier.","edition":"7"},{"key":"e_1_3_3_3_2","volume-title":"Cancer in Manitoba: 2020 Annual Statistical Report","author":"Department of Epidemiology and Cancer Registry, CancerCare Manitoba","year":"2020","unstructured":"Department of Epidemiology and Cancer Registry, CancerCare Manitoba. Cancer in Manitoba: 2020 Annual Statistical Report. Department of Epidemiology and Cancer Registry, CancerCare Manitoba; 2020."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.01.046"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2023.0141"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"issue":"2","key":"e_1_3_3_7_2","first-page":"1","article-title":"Molecular testing for thyroid nodules of indeterminate cytology: a health technology assessment","volume":"22","author":"Ontario Health (Quality)","year":"2022","unstructured":"Ontario Health (Quality). Molecular testing for thyroid nodules of indeterminate cytology: a health technology assessment. Ont Health Technol Assess Ser. 2022;22(2):1-111.","journal-title":"Ont Health Technol Assess Ser"},{"key":"e_1_3_3_8_2","unstructured":"Institut National d\u2019Excellence en Sant\u00e9 et en Services Sociaux (INESSS). Pertinence de l\u2019utilisation Des Tests Mol\u00e9culaires Pour Pr\u00e9ciser Le Diagnostic Des Nodules Thyro\u00efdiens \u00e0 Cytologie Ind\u00e9termin\u00e9e (Internet). INESSS; 2021. 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