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Journal Information
Vol. 71. Issue 7.
Pages 290-297 (August - September 2024)
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Vol. 71. Issue 7.
Pages 290-297 (August - September 2024)
Original article
Functional structure of a high resolution thyroid nodule unit. Economic impact and results of its implementation in an Endocrinology department
Estructura funcional de una unidad de alta resolución de nódulo tiroideo. Impacto económico y resultados de su implantación en un servicio de Endocrinología
Javier Bodoque Cubasa,
Corresponding author
jbodoque.ebre.ics@gencat.cat

Corresponding authors.
, José Fernández Sáezb,
Corresponding author
jfernandez@idiapjgol.info

Corresponding authors.
, Sergio Martínez Hervásc, José Vicente Gil Boixd, Juan José Salazar Gonzáleza, Raquel María Pallarés Gasullaa, Marcella Miret Llauradóa, Iñaki Argüelles Jiméneze, Santiago Tofé Povedanoe
a Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
b Unitat de suport a la recerca Terres de l’Ebre, Fundació Institut Univesitari per a la recerca a l’atenció primària de la Salut Jordi Gol, Tortosa, Tarragona, Spain
c Departament de Medicina, Universitat de València, Hospital Clínico Universitario de Valencia, Valencia, Spain
d Hospital General Universitario de Castellón, Castelló de la Plana, Spain
e Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Tables (6)
Table 1. Activity of the HRTNU at Hospital Verge de la Cinta from August 2022 through August 2023.
Table 2. Comparison between HRTNU activity (August 2022–August 2023) and Radiodiagnosis (August 2021–July 2022).
Table 3. Results of cytologies of thyroid nodules subjected to FNA by the HRTNU from August 2022 through August 2023.
Table 4. Estimation of potential direct cost savings in the HRTNU single-visit medical and ultrasound model.
Table 5. Estimation of potential direct cost savings related to fewer non-diagnostic FNAs by the HRTNU.
Table 6. Number of expected thyroid cancer cases diagnosed by the HRTNU vs Radiodiagnosis.
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Abstract
Background and objective

The high incidence of nodular thyroid pathology has led to growing concern about the economic impact that this pathology represents on the healthcare system. There are conclusive data about the cost-effectiveness of high-resolution units for nodular thyroid pathology; however, their implementation is not homogeneous in the Endocrinology and Nutrition services of our country. The objective of the present study was to evaluate the economic impact of the implementation of the high-resolution thyroid nodule unit (HRTNU) in our center.

Patients and methods

The present work is a prospective, observational and descriptive study carried out in 1314 patients (82% women, mean age 58 years ds = 11) evaluated at the HRTNU during the period of August 2022–August 2023. Demographic data (age and sex) were analyzed, referral center and consultation type, number of total consultations and neck ultrasound performed, number of fine needle aspiration (FNAB) performed, and cytology results were analyzed.

Results

In the period from August 2022 to August 2023, a total of 1314 patients were evaluated (neck ultrasound and clinical consultation) and a total of 133 FNAB were performed, of which only 2.26% were non-diagnostic. Compared to the percentage of unsatisfactory FNAB from the previous year August 2021–July 2022 of 25%, a mean saving of 9931.43 euros was estimated. 84.47% of the patients evaluated for the first time by the HRTNU were discharged, estimating a mean saving of 133,200 euros.

Conclusions

The implementation of a HRTNU at the Endocrinology and Nutrition departments, coordinated with primary and specialized care, is a cost-effectiveness alternative, as it reduces the number of medical consultations and is accompanied by a higher rate of diagnostic FNAB.

Keywords:
Thyroid nodule
High resolution
Costs
Cytology
Resumen
Antecedente y objetivo

La alta incidencia de la patología nodular tiroidea ha hecho que crezca la preocupación sobre el impacto económico que representa esta patología sobre el sistema sanitario. Existen datos concluyentes acerca del coste efectividad de las unidades de alta resolución de patología nodular tiroidea, sin embargo, su implantación no es homogénea en los servicios de Endocrinología y Nutrición de nuestro país. El objetivo del presente estudio fue evaluar el impacto económico de la puesta en marcha de la unidad de alta resolución de nódulo tiroideo (UARNT) en nuestro centro.

Pacientes y métodos

El presente trabajo es un estudio prospectivo, observacional y descriptivo en 1314 (82% mujeres, una edad media de 58 de = 11.) evaluados en la UARNT durante el periodo de Agosto 2022–Agosto 2023. Se analizaron datos demográficos (edad y sexo), especialidad de derivación, número de visitas totales realizadas, número de punción con aspiración de aguja fina (PAAF) realizadas y resultados de la citología.

Resultados

En el periodo de estudio se valoraron un total de 1314 pacientes (ecografía y visita clínica) y se realizaron un total de 133 punciones con aguja fina (PAAF) de las cuales solo un 2,26% fueron no diagnósticas. Comparado con el porcentaje de PAAF insatisfactorias del año anterior (Agosto 2021–Julio 2022) del 25%, se estimó un ahorro de 9.931,43 euros. El 84,47% de los pacientes valorados por la UARNT fueron dados de alta en el mismo acto, estimando un ahorro de 133.200 euros.

Conclusiones

La implantación de la UARNT en los servicios de Endocrinología y Nutrición coordinada con Atención Primaria y especializada es una alternativa coste eficaz, al reducir el número de visitas médicas y asociar una mayor tasa de punciones diagnósticas.

Palabras clave:
Nódulo tiroideo
Alta resolución
Costes
Citología

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