Cost analysis and resource allocation in the management of benign thyroid nodules: a comparison of surgery and thermal ablation techniques

Introduction: Benign thyroid nodules are common in adults, with incidental detection rates reaching 50–60% in women. While most nodules are asymptomatic and require no treatment, some grow and cause compressive symptoms. Objective: This study evaluates the economic impact of various treatment modalities for benign thyroid nodules within the Italian healthcare system, comparing total thyroidectomy, hemithyroidectomy, and minimally invasive thermal ablation. The analysis considers both direct healthcare costs and indirect social costs, such as productivity losses, from the perspective of the Italian National Health Service. Methods: A literature review and clinician survey were conducted to collect cost data across treatment phases: pre-hospitalization, procedure, and post-operative care. An Activity-Based Costing approach was used to estimate full treatment costs, including medical expenses, staff involvement, material usage, and indirect costs related to work absences. Results: The findings indicate that total thyroidectomy has the highest overall cost (€ 5,185.36), followed by hemithyroidectomy (€ 4,211.92), and thermal ablation (€ 1,560.06). The analysis also highlighted significant cost savings associated with thermal ablation when compared to surgical options, especially in terms of reduced hospital stay and lower indirect costs. Nevertheless, surgical procedures remain the mainstay treatment due to long-term efficacy and well-established clinical guidelines. Conclusion: Thermal ablation represents a cost-effective alternative to surgery for managing benign thyroid nodules. Treatment selection should be individualized, considering clinical factors, patient preferences, and long-term outcomes. These results underscore the importance of updating management guidelines to incorporate economic considerations, promoting optimized care and efficient resource allocation in the healthcare context.