Cheung K, Roman SA, Wang TS, Walker HD, Sosa JA
J Clin Endocrinol Metab 2008 Jun 93(6):2173-80
Commentary from Faculty Member Furio Pacini with Stefania Marchisotta
Changes Clinical Practice: Physicians in the USA should screen patients with thyroid nodules using serum CT measurement in their clinical practice.
Unlike the European consensus on thyroid cancer management,[1] current American Thyroid Association (ATA) guidelines do not recommend routine measurement of serum calcitonin (CT) in patients with thyroid nodules for the detection of medullary thyroid cancer (MTC).[2] This is the first study that measures the cost-effectiveness of routine calcitonin screening in patients with thyroid nodules in the USA and, with its meticulous analysis, can contribute to improvement of practice guidelines. The authors used a hypothetical population of adults presenting with a thyroid nodule, using data obtained from literature: the Surveillance Epidemiology and End Results (SEER) database; the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample (NIS) database; and the Medicare Reimbursement Schedule. The population was divided into two groups: the first was evaluated using current ATA guidelines, while the second was evaluated using ATA guidelines modified by the addition of serum CT measurement. The cost-effectiveness of screening thyroid nodules for the presence of MTC by serum CT measurement was demonstrated to be $11,793 per life year saved and to be comparable to the cost-effectiveness of current screening programs for breast and colon cancer and hypothyroidism. Previous studies demonstrated that routine measurement of serum CT levels should be considered an integral part of the diagnostic evaluation of thyroid nodules.[3] Since the lack of a cost-effectiveness analysis was one of the main reasons for the inability of the ATA to advocate serum CT measurement, this study adds an important contribution to solving the problem. In particular, it shows that the screening is more cost-effective in males, younger patients and patients with larger thyroid nodules, and thus the screening could be applied at least among these subgroups of patients. The only limitation of the study is that it is based on a hypothetical population; thus, it is completely dependent on the quality of the data in the literature and, as a consequence, does not provide any evidence that CT screening may have an impact on the survival of patients with MTC.
Faculty of 1000 Medicine Evaluations, Dissents and Author responses for: [Cheung K et al. Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis. J Clin Endocrinol Metab 2008 Jun 93 (6):2173-80]. 2008 Jun 23. www.f1000medicine.com/article/id/1115128/evaluation
