Fine-needle aspiration biopsy versus ultrasound-guided fine-needle aspiration biopsy: cost-effectiveness as a frontline diagnostic modality for solitary thyroid nodules.

BACKGROUND Ultrasound-guided fine-needle aspiration biopsy (ultrasound-guided FNAB) is considered the diagnostic test of choice when a fine-needle aspiration biopsy (FNAB) returns an inconclusive diagnosis because of cytologic ambiguity or paucity of specimen. METHODS Cost-effectiveness analysis utilizing a decision tree was used to model the diagnostic strategies. The decision analysis model was parameterized using costs from a large, academic medical center and probabilities from existing literature. Outcomes included the incremental cost per additional case correctly diagnosed. RESULTS All data are reported as frontline ultrasound-guided FNAB strategy versus FNAB strategy-expected cost: $1329 versus $1312; expected number of cases correctly diagnosed (per 1000 biopsies): 980 versus 920; incremental cost per additional correctly diagnosed case: $289. CONCLUSION The use of ultrasound-guided FNAB as the initial modality for tissue biopsy of a thyroid nodule is more effective than traditional FNAB at an additional cost of $289 per additional correct diagnosis.