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

PURPOSE: To compare the cost-effectiveness of (99m)Tc-methoxyisobutylisonitrile (MIBI) thyroid scintigraphy and the Afirma 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 euro1,459 - euro2,224) for the MIBI scan and 34.1 years (estimated costs euro3,560 - euro4,071) 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.