Abstract
Objectives: This study evaluated the long-term cost-effectiveness of ultrasound screening for thyroid cancer compared with non-screening in asymptomatic adults.Methods: Applying a Markov decision-tree model with effectiveness and cost data from literature, we compared the long-term cost-effectiveness of the two strategies: ultrasound screening and non-screening for thyroid cancer. A one-way sensitivity analysis and a probabilistic sensitivity analysis were performed to verify the stability of model results.Results: The cumulative cost of screening for thyroid cancer was $18,819.24, with 18.74 quality-adjusted life years (QALYs), whereas the cumulative cost of non-screening was $15,864.28, with 18.71 QALYs. The incremental cost-effectiveness ratio of $106,947.50/QALY greatly exceeded the threshold of $50,000. The result of the one-way sensitivity analysis showed that the utility values of benign nodules and utility of health after thyroid cancer surgery would affect the results.Conclusions: Ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness compared with non-screening. The optimized thyroid screening strategy for a specific population is essential.
Highlights
Thyroid cancer is one of the most common malignancies, which accounts for 1 to 1.5% of all malignant tumors in the United States [1]
In 2017, the United States Preventive Services Task Force on thyroid cancer screening online, did not endorse thyroid cancer ultrasound screening for asymptomatic adults because of the lack of evidence [9]
Active surveillance of thyroid cancer is call in lowrisk people with incidental thyroid neoplasm, most individuals go with surgical removal given inadequate evidence confirmed their lifelong safety without surgery
Summary
Thyroid cancer is one of the most common malignancies, which accounts for 1 to 1.5% of all malignant tumors in the United States [1]. With the rapid development of the ultrasound technique in the primary care, the incidence of thyroid cancer exploded in the past few decades including in Korea and many other countries [2,3,4]. In 2017, the United States Preventive Services Task Force on thyroid cancer screening online, did not endorse thyroid cancer ultrasound screening for asymptomatic adults because of the lack of evidence [9]. Korean studies demonstrated that thyroid cancer screening did not reduce the thyroid cancer-related fatality [10]. Active surveillance of thyroid cancer is call in lowrisk people with incidental thyroid neoplasm, most individuals go with surgical removal given inadequate evidence confirmed their lifelong safety without surgery. Over-diagnosis put people at the unnecessary risk of thyroid surgery such as hoarseness and primary hypoparathyroidism without a balanced benefit, leading to unnecessary labeling of lifelong diagnosis and unnecessary treatments [11]
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