National differences in cost analysis of Afirma Genomic sequencing classifier

Abstract

Context Thyroid nodules of indeterminate cytology can be subjected to molecular testing such as the Afirma Genomic Sequencing Classifier (GSC), thereby minimizing the number of unnecessary diagnostic surgeries. Objective This work aimed to evaluate and compare the cost of routine GSC testing of indeterminate thyroid nodules in different countries. Design, Patients and Main Outcome Measures The cost of diagnostic hemithyroidectomy of indeterminate thyroid nodules was calculated by performing a Monte Carlo simulation cost analysis on a Markov decision‐analytic model and then compared to that of GSC testing in the UK, Australia, USA, and Israel. Results Assuming that patients are treated by surgical resection and routine GSC testing is performed for all nodules of indeterminate significance, we found the GSC test to be more cost effective compared with diagnostic hemithyroidectomy when malignancy rates of thyroid nodules are less than 22.6%‐37.1%, depending on the country where the test is performed. Given the cost of a thyroidectomy in the UK, Australia and Israel, performing routine GSC tests on all Bethesda IV nodules is more expensive than routine diagnostic hemithyroidectomy and becomes cost effective for Bethesda III when the GSC cost is below 3,031‐3,087 USD. In comparison, in the USA, higher cost of thyroidectomy makes the GSC test cost effective for Bethesda III nodules at its current cost, but not for Bethesda IV nodules where it becomes cost effective under the price of 3,031 USD. Conclusions Different molecular testing and surgical costs in different countries should be considered when performing cost analysis. In addition, since different medical centres have different malignancy rates, personalized in‐house assessment of cost‐effectiveness is warranted.

Real-World Performance of the Afirma Genomic Sequencing Classifier (GSC)—A Meta-analysis

“…The primary goal of the test is to allow patients to avoid unnecessary surgery by ruling out thyroid cancer. A cost-effectiveness modeling study of the Afirma GSC demonstrated overall healthcare cost savings in the United States relative to routine lobectomy, along with the avoidance of potentially unnecessary surgical complications, which was seen in more than 10% of thyroid surgeries in a national study ( 25 , 26 ).…”

Revisiting the role of surgery in the treatment of Graves’ disease

“…In the absence of similar definitions for complication, length of follow‐up and its quality, a simple conclusion that surgery carries high costs or is not cost‐effective, as written in leading reviews, 42–44 should be done with caution, as the studies in which it was based on may have been exposed to substantial bias. Moreover, differences in thyroidectomy costs between countries were shown to considerably affect cost‐analysis considerations in other scenarios 80 …”

“…Moreover, differences in thyroidectomy costs between countries were shown to considerably affect cost-analysis considerations in other scenarios. 80…”