Context: European studies have shown that use of routine calcitonin screening for detection of medullary thyroid cancer (MTC) in patients with thyroid nodules increases the detection of occult MTC and may improve patient outcomes. Calcitonin screening for MTC has not been recommended in recent U.S. practice guidelines.

Objective: To determine the cost-effectiveness of routine calcitonin screening in adult patients with thyroid nodules in the U.S.

Settings/Subjects: A decision model was developed for a hypothetical group of adult patients presenting for evaluation of thyroid nodules in the U.S. Patients were screened using current American Thyroid Association guidelines only, or American Thyroid Association guidelines with routine serum calcitonin screening. Input data were obtained from the literature, SEER and HCUP-NIS databases, and the Medicare Reimbursement Schedule. Sensitivity analyses were performed for a number of input variables.

Main Outcome Measures: Cost-effectiveness, measured in dollars per life years saved ($/LYS).

Results: Addition of calcitonin screening to current American Thyroid Association guidelines for the evaluation of thyroid nodules would cost $11,793/LYS ($10,941–12,646/LYS). When extrapolated to the national level, calcitonin screening for MTC in the U.S. would yield an additional 113,000 life-years at a cost increase of 5.3%. Calcitonin screening cost-effectiveness is sensitive to patient age and gender, and to changes in disease prevalence, specificity of fine needle aspiration and calcitonin testing, calcitonin screening level, costs of testing, and length of follow-up.

Conclusions: Routine serum calcitonin screening in patients undergoing evaluation for thyroid nodules appears to be cost-effective in the U.S., with cost-effectiveness comparable to measurement of thyroid stimulating hormone, colonoscopy, and mammography screening.