title: Cost-effectiveness of universal and risk-based screening for autoimmune thyroid disease in pregnant women.
abstract: BACKGROUND
  Hypothyroidism in pregnancy can lead to adverse maternal and fetal outcomes. Although screening of high-risk women is advocated, universal screening remains controversial.
  
  
  OBJECTIVE
  The objective of the study was to compare the cost-effectiveness of universal screening of pregnant women for autoimmune thyroid disease (AITD) with screening only high-risk women and with no screening.
  
  
  METHODS
  A decision-analytic model compared the incremental cost per quality-adjusted life-year (QALY) gained among the following: 1) universal screening, 2) high-risk screening, and 3) no screening. Screening consisted of a first-trimester thyroid-stimulating hormone level and antithyroid peroxidase antibodies. Women with abnormal results underwent further testing and, when indicated, levothyroxine therapy. Randomized controlled trials provided probabilities for adverse obstetrical outcomes. The model accounted for the development of postpartum thyroiditis and overt hypothyroidism. Additional scenarios in which therapy prevented cases of decreased child intelligence quotient were explored.
  
  
  METHODS
  Medical consequences of AITD in pregnancy, QALY, and costs were measured.
  
  
  RESULTS
  Risk-based screening and universal screening were both cost-effective relative to no screening, with incremental cost-effectiveness ratios (ICERs) of $6,753/QALY and $7,138/QALY, respectively. Universal screening was cost-effective compared with risk-based screening, with an ICER of $7,258/QALY. Screening remained cost-effective in various clinical scenarios, including when only overt hypothyroidism was assumed to have adverse obstetrical outcomes. Universal screening was cost-saving in the scenario of untreated maternal hypothyroidism resulting in decreased child intelligence, with levothyroxine therapy being preventive.
  
  
  CONCLUSIONS
  Universal screening of pregnant women in the first trimester for AITD is cost-effective, not only compared with no screening but also compared with screening of high-risk women.
authors.affiliation: Division of Endocrinology, Stanford University School of Medicine, 300 Pasteur Drive, S025, Stanford, California 94305, USA. cdosiou@stanford.edu
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Dosiou
authors.forename: James
authors.initials: J
authors.lastname: Barnes
authors.forename: Alan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Roberto
authors.initials: R
authors.lastname: Negro
authors.forename: Lawrence
authors.initials: L
authors.lastname: Crapo
authors.forename: Alex
authors.initials: A
authors.lastname: Stagnaro-Green
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000191:economics*; D037841:Pregnant People; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D013967:Thyroiditis, Autoimmune / Q000175:diagnosis / Q000191:economics*