The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism.
OBJECTIVE
The purpose of this study was to determine whether routine screening for subclinical hypothyroidism during pregnancy would be cost-effective.


METHODS
We developed a decision analysis model to compare the cost-effectiveness of 2 screening strategies during pregnancy for subclinical hypothyroidism: (1) no routine screening of serum thyroid-stimulating hormone (TSH) levels (standard) and (2) routine screening of TSH levels. In the latter, women with subclinical hypothyroidism received thyroid hormone replacement. We assumed that thyroid hormone replacement could reduce the incidence of an offspring IQ < 85 for pregnancies with subclinical hypothyroidism. The main outcome measure was marginal cost per quality-adjusted life year (QALY) gained.


RESULTS
Our model predicts that universal screening is the dominant strategy. For every 100,000 pregnant women who were screened, $8,356,383 are saved, and 589.3 QALYs are gained. When subclinical hypothyroidism prevalence is reduced to 0.25%, screening remains cost-effective at $21,664/QALY gained.


CONCLUSIONS
Screening for subclinical hypothyroidism in pregnancy will be a cost-effective strategy under a wide range of circumstances.
Thung
Stephen F
SF
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, USA.
Funai
Edmund F
EF
Grobman
William A
WA
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D015994:Incidence; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D013972:Thyrotropin / Q000097:blood
D013972:Thyrotropin