FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial

Elizabeth J. de Koster; Dennis Vriens; the EfFECTS trial study group; Maarten O. van Aken; Lioe Ting Dijkhorst-Oei; Wim J.G. Oyen; Robin P. Peeters; Abbey Schepers; Lioe Fee de Geus-Oei; Wilbert B. van den Hout

doi:10.1007/s00259-022-05794-w

FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial

Elizabeth J. de Koster^*
, Dennis Vriens
, the EfFECTS trial study group
, Maarten O. van Aken
, Lioe Ting Dijkhorst-Oei
, Wim J.G. Oyen
, Robin P. Peeters
, Abbey Schepers
, Lioe Fee de Geus-Oei
, Wilbert B. van den Hout

^*Corresponding author for this work

Internal Medicine

Radboud University Medical Center
Leiden University Medical Centre
Haga Ziekenhuis
Meander Medical Center
Rijnstate Hospital
Humanitas University
University of Twente

Research output: Contribution to journal › Article › Academic › peer-review

18 Citations (Scopus)

105 Downloads (Pure)

Abstract

Purpose: To evaluate cost-effectiveness of an [¹⁸F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [¹⁸F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules. Methods: Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [¹⁸F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. Results: The observed 1-year cost difference of [¹⁸F]FDG-PET/CT as compared to diagnostic surgery was − €1000 (95% CI: − €2100 to €0) for thyroid nodule–related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was − €4500 (− €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was − €9900 (− €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (− 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (− 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [¹⁸F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty. Conclusion: Following the observed reduction in diagnostic surgery, an [¹⁸F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule–related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.

Original language	English
Pages (from-to)	3452-3469
Number of pages	18
Journal	European Journal of Nuclear Medicine and Molecular Imaging
Volume	49
Issue number	10
DOIs	https://doi.org/10.1007/s00259-022-05794-w
Publication status	Published - Aug 2022

Bibliographical note

Funding Information:
The EfFECTS trial was supported by a project grant from the Dutch Cancer Society (KUN 2014–6514).

Publisher Copyright: © 2022, The Author(s).

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Koster2022_Article_FDG-PETCTInIndeterminateThyroiFinal published version, 1.62 MBLicence: CC BY

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de Koster, E. J., Vriens, D., the EfFECTS trial study group, van Aken, M. O., Dijkhorst-Oei, L. T., Oyen, W. J. G., Peeters, R. P., Schepers, A., de Geus-Oei, L. F., & van den Hout, W. B. (2022). FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial. European Journal of Nuclear Medicine and Molecular Imaging, 49(10), 3452-3469. https://doi.org/10.1007/s00259-022-05794-w

@article{1c6df7f8f93e4fb09e61697b75f8d225,

title = "FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial",

abstract = "Purpose: To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40\% of futile diagnostic surgeries for benign Bethesda III/IV nodules. Methods: Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. Results: The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was − €1000 (95\% CI: − €2100 to €0) for thyroid nodule–related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was − €4500 (− €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was − €9900 (− €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (− 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (− 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84\% certainty. Conclusion: Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule–related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.",

author = "\{de Koster\}, \{Elizabeth J.\} and Dennis Vriens and \{the EfFECTS trial study group\} and \{van Aken\}, \{Maarten O.\} and Dijkhorst-Oei, \{Lioe Ting\} and Oyen, \{Wim J.G.\} and Peeters, \{Robin P.\} and Abbey Schepers and \{de Geus-Oei\}, \{Lioe Fee\} and \{van den Hout\}, \{Wilbert B.\}",

note = "Funding Information: The EfFECTS trial was supported by a project grant from the Dutch Cancer Society (KUN 2014–6514). Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = aug,

doi = "10.1007/s00259-022-05794-w",

language = "English",

volume = "49",

pages = "3452--3469",

number = "10",

}

de Koster, EJ, Vriens, D, the EfFECTS trial study group, van Aken, MO, Dijkhorst-Oei, LT, Oyen, WJG, Peeters, RP, Schepers, A, de Geus-Oei, LF & van den Hout, WB 2022, 'FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial', European Journal of Nuclear Medicine and Molecular Imaging, vol. 49, no. 10, pp. 3452-3469. https://doi.org/10.1007/s00259-022-05794-w

FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial. / de Koster, Elizabeth J.; Vriens, Dennis; the EfFECTS trial study group et al.
In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 49, No. 10, 08.2022, p. 3452-3469.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - FDG-PET/CT in indeterminate thyroid nodules

T2 - cost-utility analysis alongside a randomised controlled trial

AU - de Koster, Elizabeth J.

AU - Vriens, Dennis

AU - the EfFECTS trial study group

AU - van Aken, Maarten O.

AU - Dijkhorst-Oei, Lioe Ting

AU - Oyen, Wim J.G.

AU - Peeters, Robin P.

AU - Schepers, Abbey

AU - de Geus-Oei, Lioe Fee

AU - van den Hout, Wilbert B.

PY - 2022/8

Y1 - 2022/8

N2 - Purpose: To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules. Methods: Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. Results: The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was − €1000 (95% CI: − €2100 to €0) for thyroid nodule–related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was − €4500 (− €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was − €9900 (− €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (− 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (− 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty. Conclusion: Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule–related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.

AB - Purpose: To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules. Methods: Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. Results: The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was − €1000 (95% CI: − €2100 to €0) for thyroid nodule–related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was − €4500 (− €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was − €9900 (− €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (− 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (− 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty. Conclusion: Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule–related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.

UR - https://www.scopus.com/pages/publications/85128387428

U2 - 10.1007/s00259-022-05794-w

DO - 10.1007/s00259-022-05794-w

M3 - Article

C2 - 35435497

AN - SCOPUS:85128387428

SN - 1619-7070

VL - 49

SP - 3452

EP - 3469

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

IS - 10

ER -

FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial

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