INTRODUCTION: Radiofrequency ablation (RFA) is a minimally invasive treatment for benign thyroid nodules (BTN). However, the expected costs for RFA are unclear from a healthcare payer perspective as many payers have not defined reimbursement for RFA. Therefore, the objective of this study was to estimate one-year costs, including treatment and complication management, for RFA relative to thyroid lobectomy for patients with BTN and ultimately estimate a potential reimbursement threshold.
METHODS: A decision tree model was created to model the natural history of BTN following treatment with RFA and lobectomy. Patients who underwent RFA were assumed to receive 1.2 treatment sessions on average. Probabilities of complications were obtained from the literature and electronic health record data. Costs were estimated from the healthcare payer perspective and derived from the Center for Medicare & Medicaid Services (CMS) fee schedule. Reimbursement of RFA for BTN is not yet defined. Therefore, we conservatively assumed a cost of $5,000 per session. Sensitivity analyses were performed to examine how sensitive the results were to changes in model parameters and to determine an equivalence threshold.
RESULTS: The total one-year costs for RFA were $6,022, which was greater than the one-year costs of lobectomy, which were $4,492. However, in the sensitivity analysis, RFA became less costly when its cost fell 10.3% below the cost of lobectomy to $3,725. Complications included post-operative pain, hematoma, hypothyroidism, and hoarseness. RFA had lower rates of all complications compared to thyroid lobectomy. One-way sensitivity analyses suggested that these results were most sensitive to changes in costs of RFA and lobectomy and robust to the probabilities and costs of complications.
CONCLUSIONS: RFA has lower probabilities of all complications and lower expected one-year costs for complication management than lobectomy. A reimbursement threshold of $3,725 per session for RFA provides a similar one-year cost to lobectomy under the other assumptions in our model.
