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Ayesha N. Khalid, MD; Christopher S. Hollenbeak, PhD; Sadeq A. Quraishi, MD, MHA; Chris Y. Fan, MD; Brendan C. Stack, Jr, MD

Arch Otolaryngol Head Neck Surg. 2006;132:244-250.

Objective  To compare the cost-effectiveness of fine-needle aspiration biopsy, iodine 131 scintigraphy, and ultrasonography for the initial diagnostic workup of a solitary palpable thyroid nodule.

Design  A deterministic cost-effectiveness analysis was conducted using a decision tree to model the diagnostic strategies.

Setting  A single, mid-Atlantic academic medical center.

Main Outcome Measures  Expected costs, expected number of cases correctly diagnosed, and incremental cost per additional case correctly diagnosed.

Results  Relative to the routine use of fine-needle aspiration biopsy, the incremental cost per case correctly diagnosed is $24 554 for the iodine 131 scintigraphy strategy and $1212 for the ultrasound strategy.

Conclusions  A diagnostic strategy using initial fine-needle aspiration biopsy for palpable thyroid nodules was found to be cost-effective compared with the other approaches as long as a payor's willingness to pay for an additional correct diagnosis is less than $1212. Prospective studies are needed to validate these finding in clinical practice.

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery, Department of Surgery (Drs Khalid and Stack), Departments of Surgery (Dr Hollenbeak), Health Evaluation Sciences (Dr Hollenbeak), and Anesthesiology (Dr Quraishi), and Division of Endocrinology and Metabolism, Department of Medicine (Dr Fan), Pennsylvania State University College of Medicine, Hershey; and Department of Health Studies, Lehigh Valley Hospital, Allentown, Pa (Dr Hollenbeak). Dr Stack is now with the Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock.

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