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.
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