Cost effectiveness analysis of BRAFV600E testing for low-risk papillary thyroid microcarcinomas.

OBJECTIVE

Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs), accurate risk stratification is valuable to optimize management: active surveillance (AS) vs. hemithyroidectomy (HT). BRAFV600E positive lrPTMC is associated with increased recurrence risk; hence, AS was suggested for mutation-negative lrPTMC. This study aims to evaluate the cost-effectiveness of BRAFV600E testing for lrPTMC.

STUDY DESIGN &

SETTING

Decision tree cost-effectiveness analytic model.

METHODS

We performed a cost-effectiveness analysis of the management strategies for lrPTMCs: AS, HT, and BRAFV600E genetic testing (GT), in which treatment pathways were determined by BRAFV600E status. Data on probabilities and complications were derived from current literature. One- and two-way sensitivity analyses were conducted to ascertain model robustness.

RESULTS

Our model found GT as the cost-effective strategy, providing an additional 0.35 QALYs and an additional cost of $902 with an Incremental Cost-effectiveness ratio of $2542 compared to AS. In contrast, surgical intervention showed a lower utility with an increased cost of $381, positioning GT as the preferred strategy. Sensitivity analysis identified age at diagnosis as the most influential factor for cost-effectiveness between AS and GT; younger patients exhibited a lower ICER, indicating greater cost savings per QALY, till up to age 48 years, where AS becomes favorable. GT consistently outperformed QALY gains across varying incidences of BRAFV600E positivity tumors.

CONCLUSIONS

In conclusion, this study demonstrates the economic and clinical advantages of incorporating BRAFV600E genetic testing in the management of lrPTMCs. Our model supports further real-life studies of BRAFV600E testing for lrPTMCs.