National Trends in Thyroidectomy and Molecular Diagnostic Utilization: A Medicare Analysis (2016-2023).

Abstract

As healthcare expenditures rise, characterizing the national utilization and economic footprint of genomic sequencing classifiers (GSCs) for indeterminate thyroid nodules is essential. We evaluated adoption trends and Medicare spending for primary GSC platforms (Afirma, ThyroSeq, and ThyGeNEXT/ThyraMIR) over 8 years. We conducted a retrospective analysis of Medicare Part B Provider Utilization and Payment data (2016-2023). GSC and surgical services were identified via CPT codes. Medicare payments were adjusted to 2016 U.S. dollars using the Medical Care Consumer Price Index. Trends were evaluated using linear regression. Total GSC utilization increased from 4478 services in 2016 to 13,456 in 2023 (200.5% increase). GSC adoption as percentage of fine-needle aspirations increased from 2.11% to 7.71% (p < 0.001). Afirma was the primary driver, increasing from 4478 to 9273 services (p < 0.001). Following the introduction of Proprietary Laboratory Analyses codes, ThyroSeq and ThyGeNEXT/ThyraMIR demonstrated rapid uptake, reaching 509 and 3674 annual services by 2023, respectively. Concurrent with increased GSC adoption, total thyroidectomy procedures declined 42.1% (p < 0.001), while lobectomy procedures decreased 20.7% (p = 0.006), indicating surgical de-escalation. Inflation-adjusted Medicare expenditures for GSCs rose significantly from $14.0 million to $35.3 million (p = 0.002), but average adjusted payment per Afirma test remained stable ($2963-$3366, p = 0.218). This Medicare-based national analysis demonstrates GSC utilization tripled from 2016 to 2023, temporally associated with substantial surgical de-escalation. This population-level correlation may reflect the clinical impact of molecular diagnostics in reducing potentially unnecessary thyroid surgery. Expenditure growth was driven by adoption rather than price inflation. N/A.