title: [Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain].
abstract: OBJECTIVE
  To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening.
  
  
  METHODS
  A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only.
  
  
  RESULTS
  Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System.
  
  
  CONCLUSIONS
  Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.
authors.affiliation: Unidad de Endocrinología y Nutrición, Hospital Universitario Fundación Alcorcón, Madrid, España. Electronic address: SDonnay@fhalcorcon.es.
authors.forename: Sergio
authors.initials: S
authors.lastname: Donnay Candil
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Universitario Infanta Sofía, Madrid, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Balsa Barro
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
authors.forename: Julia
authors.initials: J
authors.lastname: Álvarez Hernández
authors.affiliation: Departamento de Estadística, Universidad de Barcelona, Barcelona, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Crespo Palomo
authors.affiliation: Oblikue Consulting, Barcelona, España.
authors.forename: Ferrán
authors.initials: F
authors.lastname: Pérez-Alcántara
authors.affiliation: Economía de la Salud, Corporate Affairs, Merck S.L., España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Polanco Sánchez
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics*; D062145:Maternal Serum Screening Tests / Q000191:economics*; D009313:National Health Programs / Q000191:economics*; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013030:Spain / Q000453:epidemiology; D013960:Thyroid Function Tests / Q000191:economics* / Q000706:statistics & numerical data
keywords: Análisis coste-efectividad; Cost effectiveness analysis; Hipotiroidismo; Hipotiroidismo subclínico; Hypothyroidism; Mujeres embarazadas; Pregnant women; Subclinical hypothyroidism