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Universal screening for thyroid disease in pregnancy most cost-effective option
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Annual Meeting of the ATA
INDIAN WELLS, Calif. - Universal screening for autoimmune thyroid disease with thyroid-stimulating hormone and antithyroid peroxidase antibodies boasted better cost-effectiveness compared with no screening or screening of high-risk women only, a speaker said here.
Recommendations issued by several societies, including the Endocrine Society and the American Thyroid Association, support selective screening for thyroid disease in high-risk pregnant women, according to Chrysoula Dosiou, MD, MS,of Stanford University School of Medicine. Such risk-based screening, however, has been shown to miss at least 30% of cases of overt and subclinical hypothyroidism, she said during a presentation.
Research also indicates screening in general is cost-effective, but no studies have compared the costs of not screening with both universal screening and screening of high-risk pregnant women only, Dosiou noted. Therefore, she and colleagues developed a model to measure the incremental cost per quality-adjusted life-year of different screening strategies. They screened women in the first trimester of pregnancy with antithyroid peroxidase (anti-TPO) antibodies and TSH. Women with positive results underwent further testing and initiated treatment with levothyroxine, when indicated. The researchers performed a lifetime analysis using data from the literature to create assumptions regarding age at pregnancy, disease prevalence, cost of screening, annual levothyroxine cost and other variables. Probabilities for adverse obstetrical outcomes were derive from data obtained from randomized, controlled clinical trials, according to Dosiou.
According to results, both risk-based and universal screening were cost-effective compared with no screening. Incremental cost-effectiveness ratios were $6,753 per quality-adjusted life-year and $7,119 per quality-adjusted life-year, respectively. Universal screening was also more cost-effective than risk-based screening, having an incremental cost-effectiveness of $7,258 per quality-adjusted life-year. Sensitivity analyses supported the robustness of their findings, according to Dosiou.
Furthermore, the researchers' results persisted across a range of hypothetical clinical scenarios, including one in which they doubled the screening costs, Dosiou said.
"Also, in a very interesting clinical scenario in which we assumed no benefit of detection of subclinical hypothyroidism and benefits of screening were limited to detection and treatment of overt hypothyroidism with close follow-up of anti-TPO antibody-positive patients for development of postpartum thyroiditis and overt hypothyroidism, should they develop after pregnancy, screening remained cost-effective," she said. Similarly, when assuming that untreated hypothyroidism would detrimentally affect the child's IQ, while also assuming that this would be prevented by treatment with levothyroxine, universal screening was cost-saving.
Dosiou concluded: "Taking into account all of our results, we believe the medical community should strongly consider incorporating a TSH and anti-TPO antibody level to the tests of the first prenatal visit."
For more information:
- Dosiou C. Oral 10. Presented at: the 81st Annual Meeting of the American Thyroid Association; Oct. 26-30, 2011; Indian Wells, Calif.
Disclosure: Dr. Dosiou reports no relevant financial disclosures.
I think the study was very well executed and has important results, but at this point, there are not enough studies and enough people to make definitive recommendations.
- Anne Cappola, MD, ScM
Associate Professor of
Medicine, Perelman School of Medicine,
University of Pennsylvania
Disclosure: Dr. Cappola reports no relevant financial disclosures.
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