Authors' objectives: This health technology assessment evaluates the effectiveness, safety, and cost-effectiveness of ablative technologies for the treatment of symptomatic benign thyroid nodules, cystic thyroid nodules, autonomously functioning thyroid nodules (AFTNs), or small, low-risk papillary thyroid cancer in adults. It also evaluates the budget impact of publicly funding ablative technologies and the experiences, preferences, and values of adults with symptomatic benign thyroid nodules, cystic thyroid nodules, AFTNs, or small, low-risk papillary thyroid cancer.

Authors' results and conclusions: Ablative technologies may be as effective as surgery for patients with symptomatic benign thyroid nodules or small, low-risk papillary thyroid cancer, and they may also be safer. Effectiveness and safety among the different ablative technologies may be similar, but the evidence was inconclusive. In patients with symptomatic thyroid nodules and AFTNs, RFA is more effective and less costly than surgery. In patients with small, low-risk papillary thyroid cancer, RFA is more effective and less costly than surgery and cost-effective compared with active surveillance. We estimate that publicly funding RFA for patients with symptomatic benign thyroid nodules, AFTNs, and small, low-risk papillary thyroid cancer in Ontario would result in cost savings of $5.42 million, $0.64 million, and $4.03 million over the next 5 years, respectively. Thyroid nodules have a negative impact on people's physical and emotional well-being, affecting daily activities, work, and overall quality of life. The people we interviewed expressed a preference for minimally invasive treatment options such as RFA, noting benefits such as shorter recovery times and less reliance on lifelong medication as a result of preserved thyroid function.

Authors' recommendations: Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends publicly funding radiofrequency ablation for adults with symptomatic benign thyroid nodules, autonomously functioning thyroid nodules, and small, low-risk papillary thyroid cancer who are being considered for surgery.

Authors' methods: We performed a systematic literature search of the clinical evidence to retrieve systematic reviews; we then complemented the chosen systematic reviews with a literature search to identify primary studies published from January 2022. We assessed the risk of bias of each included study using the Risk of Bias in Systematic Reviews tool for systematic reviews and the Cochrane Risk-of-Bias Tool 2 for primary studies. We assessed the quality of the body of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted cost-utility analyses with a lifetime horizon from a public payer perspective. We also analyzed the budget impact of publicly funding radiofrequency ablation (RFA) in adults with symptomatic benign thyroid nodules, AFTNs, and small, low-risk papillary thyroid cancer in Ontario. To contextualize the potential value of RFA, we spoke with people who had thyroid nodules.

Project Status: Completed

URL for project: https://ontariohealth.ca/system/health-innovation-pathway/reviews/hta-details?cf=ablative-technologies-thyroid-nodules

URL for protocol: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251006858

Year Published: 2026

URL for published report: https://pmc.ncbi.nlm.nih.gov/articles/PMC13268792/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Ontario

Pubmed ID: 42311839

Organisation Name: Ontario Health

Contact Address: 525 University Ave, Toronto, ON M5G 2L3

Contact Name: HealthInnovationPathway@ontariohealth.ca

Contact Email: HealthInnovationPathway@ontariohealth.ca

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