Thyroid nodules with indeterminate cytology: molecular imaging with 99mTc-methoxyisobutylisonitrile (MIBI) is more cost-effective than the AfirmaA® gene expression classifier

Purpose To compare the cost-effectiveness of Tc-99m-methoxyisobutylisonitrile (MIBI) thyroid scintigraphy and the AfirmaA (R) gene expression classifier for the assessment of cytologically indeterminate thyroid nodules. Methods A decision tree model was used. Costs were calculated from the perspective of the German health insurance system. The robustness of the results was assessed with probabilistic sensitivity analyses using a Monte Carlo simulation. Results Life expectancy was 34.3 years (estimated costs per patient a,not sign1,459 - a,not sign2,224) for the MIBI scan and 34.1 years (estimated costs a,not sign3,560 - a,not sign4,071) for the molecular test. These results were confirmed by the Monte Carlo simulation. Conclusion MIBI thyroid scintigraphy is more cost-effective than the gene expression classifier.