The cost-effectiveness of iodine 131 scintigraphy, ultrasonography, and fine-needle aspiration biopsy in the initial diagnosis of solitary thyroid nodules

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.