Manitoba Thyroid Tests Point to Smarter Nodule Care

In Manitoba's publicly funded care system, researchers looked at whether molecular tests for thyroid nodules make sense for the money. The focus was nodules that came back Bethesda III or IV after fine-needle aspiration biopsy. That means the result was not clearly benign or cancerous. People had to be 18 or older and receive FNAB in Manitoba.

Using 2023 records, the team reviewed FNAB and lobectomy data from the province. They priced surgery, follow-up care, testing, and complications in 2023 Canadian dollars. Six options were checked: Afirma, ThyroSeqV3, ThyroidPrint, ThyroSPEC, ThyGeNEXT/ThyraMIR, and mir-THYpe. The model used a local cancer rate of 21% among indeterminate nodules and published test performance numbers.

The comparison had three routes: today's usual care, adding one of the molecular tests, or going straight to diagnostic lobectomy. The team counted total yearly costs. They also calculated quality-adjusted life-years and incremental cost-effectiveness ratios. A $50,000 per QALY threshold was used to judge the results.

Among 1,486 FNABs, 413 were indeterminate and 149 patients had diagnostic lobectomy. Lobectomy cost $7,542.69 per patient. Each molecular strategy improved net QALYs compared with current care. Its ICERs fell between $9,791.03 and $58,749.94 per QALY. At the $50,000/QALY threshold, every test except Afirma looked cost-effective against current care.

Against the reference standard of diagnostic lobectomy, all six molecular strategies were dominant. In plain terms, the model favored them over lobectomy on cost-effectiveness. The findings suggest molecular testing could help avoid some surgeries that may not be needed, while keeping patient outcomes intact in this Manitoba setting. That may give policymakers a clearer way to discuss where money goes in thyroid nodule care.