{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:14:51Z","timestamp":1792800891172,"version":"4.5.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15\u201330% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, these tests are associated with significant costs. The objective of this study was to evaluate the cost-effectiveness of Afirma, a commercially available molecular test, in cytologically indeterminate thyroid nodules. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> The base case was a solitary thyroid nodule with no additional high-risk features and an indeterminate FNA. Decision tree analysis was performed from the single payer perspective with a 1-year time horizon. Costing data were collected through micro-costing methodology. A probabilistic sensitivity analysis was performed. The primary outcome was the incremental cost effectiveness ratio (ICER) of cost per thyroid surgery avoided. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Over 1\u00a0year, mean cost estimates were $8176.28 with 0.58 effectiveness for the molecular testing strategy and $6016.83 with 0.07 effectiveness for current standard management. The ICER was $4234.22 per surgery avoided. At a willingness-to-pay (WTP) threshold of $5000 per surgery avoided, molecular testing is cost-effective with 63% certainty. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> This cost-effectiveness analysis suggests utilizing Afirma for indeterminate solitary thyroid nodules is a cost-effective strategy for avoiding unnecessary thyroid surgery. With a $5000 WTP threshold, molecular testing has a 63% chance of being the more cost-effective strategy. The cost effectiveness varies based on the cost of the molecular test and the value of Afirma for patients with indeterminate thyroid nodules depends on the WTP threshold to avoid unnecessary thyroid surgery. <\/jats:p><\/jats:sec><jats:sec><jats:title>Graphical Abstract<\/jats:title><jats:p> <\/jats:p><\/jats:sec>","DOI":"10.1186\/s40463-022-00604-7","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T15:03:07Z","timestamp":1671634987000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":32,"title":["Cost-effectiveness analysis of molecular testing for cytologically indeterminate thyroid nodules"],"prefix":"10.1177","volume":"51","author":[{"given":"Navjit","family":"Dharampal","sequence":"first","affiliation":[{"name":"Section of Thoracic Surgery, Providence Cancer Institute, Portland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Utah, Salt Lake City, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Harvey","sequence":"additional","affiliation":[{"name":"Section of General Surgery, Department of Surgery, University of Calgary, Calgary, Canada"},{"name":"Section of Surgical Oncology, Department of Oncology, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Paschke","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Rudmik","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology, Department of Surgery, University of Calgary, Foothills Medical Centre, North Tower Rm 1012, 1403 29 St NW, T2N2T9, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6612-4717","authenticated-orcid":false,"given":"Shamir","family":"Chandarana","sequence":"additional","affiliation":[{"name":"Section of Otolaryngology, Department of Surgery, University of Calgary, Foothills Medical Centre, North Tower Rm 1012, 1403 29 St NW, T2N2T9, Calgary, AB, Canada"},{"name":"Section of Surgical Oncology, Department of Oncology, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,1,1]]},"reference":[{"key":"bibr1-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2008.09.019"},{"key":"bibr2-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6413-5-6"},{"key":"bibr3-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPPHLWMI3JV4LA"},{"key":"bibr4-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"bibr5-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1159\/000339959"},{"key":"bibr6-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0110"},{"key":"bibr7-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1203208"},{"key":"bibr8-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012.0180"},{"key":"bibr9-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.4274\/2017.26.suppl.05"},{"key":"bibr10-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24250"},{"key":"bibr11-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2482"},{"key":"bibr12-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13165"},{"key":"bibr13-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0459"},{"key":"bibr14-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31819bc064"},{"key":"bibr15-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.4616"},{"key":"bibr16-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2019.05.079"},{"key":"bibr17-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2017.10.004"},{"key":"bibr18-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13096"},{"key":"bibr19-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-3048"},{"key":"bibr20-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1219"},{"key":"bibr21-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2001.118370"},{"key":"bibr22-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31819bc09d"},{"key":"bibr23-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.1829"},{"key":"bibr24-s40463-022-00604-7","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2018.0779"}],"container-title":["Journal of Otolaryngology - Head &amp; 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