Cost Outcomes Rarely Included in Thyroid Cancer Clinical Trials
Key Takeaways
- Only 2.3% of thyroid cancer trials registered on ClinicalTrials.gov reported any cost-related outcomes.
- Cost was a primary endpoint in just 1 of 1196 reviewed trials, limiting economic evidence for care pathways.
- The findings highlight a critical gap in integrating cost-effectiveness into value-based thyroid cancer management.
Economic considerations are increasingly central to oncology care, yet their role in thyroid cancer research remains unclear. A new review of ClinicalTrials.gov data found that cost outcomes are rarely incorporated into thyroid cancer clinical trials, despite rising treatment complexity and health care spending. The findings underscore a disconnect between clinical research priorities and value-based care needs relevant to clinical pathways.
Study Findings
Investigators reviewed 1196 thyroid cancer–focused clinical trials listed on ClinicalTrials.gov and identified only 28 trials (2.3%) that mentioned cost in the study description or outcomes. Among these, cost was explicitly listed as a primary outcome in just 1 trial (2.2%). Cost appeared more often as a secondary outcome in 20 trials (43.5%) or as an exploratory or descriptive endpoint in 7 trials (15.2%).
Of the 28 trials incorporating cost, 25 (89%) were interventional and 3 (11%) were observational. Surgical interventions were the most common modality studied (39%), followed by radiation therapy (32%) and imaging (21%). Cost analyses were most often embedded within broader assessments of quality of life, health care resource utilization, or patient-reported outcomes rather than evaluated independently.
Geographically, trials reporting cost outcomes were concentrated outside the US. France accounted for the largest share (29%), followed by China (18%). Only 2 US-based trials included cost endpoints, one conducted in the Northeast and one in the South. Notably, none of the cost-focused trials received funding from the National Institutes of Health, and only one trial (4%) was industry sponsored. Most studies were funded by academic or institutional sources.
Trial enrollment varied widely, with a mean enrollment of approximately 333 patients and a median of 290. While some large observational studies skewed enrollment upward, many trials remained modest in size. At the time of review, 36% of trials were completed, while the remainder were recruiting, not yet recruiting, or of unknown status.
Clinical Implications
For clinicians and health systems designing thyroid cancer pathways, the limited availability of cost data presents a challenge. Thyroid cancer care often involves surgery, radiation, imaging, and long-term surveillance—components that contribute substantially to cumulative costs over a patient’s lifetime. Without robust cost or cost-effectiveness data from clinical trials, it is difficult to assess the value of emerging therapies or compare competing treatment strategies.
The findings suggest that clinical trial design continues to prioritize efficacy and safety over economic impact. As health care systems increasingly adopt value-based models, the absence of cost endpoints limits the ability of clinicians, payers, and pathway developers to align treatment decisions with sustainability goals. Incorporating standardized cost and cost-effectiveness measures into future thyroid cancer trials could support more informed clinical decision-making and pathway optimization.
Conclusion
This review highlights a significant underrepresentation of cost outcomes in thyroid cancer clinical trials. As value-based care becomes central to oncology practice, greater integration of economic endpoints into trial design will be essential to support evidence-based, cost-conscious clinical pathways in thyroid cancer care.
Reference
Rogers JL, Henostroza S, Fahey A, Solórzano CC. Cost analysis in thyroid cancer clinical trials: toward value-based oncology care. Am J Surg. 2026 Feb;252:116772. doi:10.1016/j.amjsurg.2025.116772.
