Date and Time
January 26, 2005
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Christy Dosiou, MD - Instructor in the Division of Endocrinology at the Stanford School of Medicine; Master's Degree Student in Clinical Epidemiology

ABSTRACT of the research to be presented:

BACKGROUND: Maternal hypothyroidism, if left untreated during pregnancy, can have serious adverse consequences for maternal and fetal health and can result in decreased IQ in the offspring. Previous cost-effectiveness analyses of screening for thyroid disease have focused on screening adults above 35 years of age and above 60 years of age respectively. A recent consensus conference has found insufficient evidence for or against screening for thyroid disease in pregnant women.

OBJECTIVE: To examine the cost-effectiveness of screening pregnant women (aged 15-49 years) for autoimmune thyroid disease.

METHODS: We developed a state-transition Markov model to estimate the incremental cost per quality-adjusted life year (QALY) gained by screening pregnant women with anti-thyroid peroxidase (anti-TPO) antibodies versus not screening. Our screening strategy consists of a one-time screen in the first trimester of pregnancy followed by further testing if the screen is positive and subsequent treatment of women with hypothyroidism. The model accounts for medical consequences of autoimmune thyroid disease and hypothyroidism such as the development of gestational hypertension, postpartum thyroiditis, and low IQ in the infants of untreated hypothyroid mothers. We performed a lifetime analysis taking a societal perspective. We made base case assumptions on the age at pregnancy (25 years), disease prevalence (11%), sensitivity of test (0.90), cost of screening ($20), annual levothyroxine medication cost ($131) and other variables, and varied these parameters in sensitivity analyses.

RESULTS: In the base case analysis, the cost-effectiveness of screening was $11,661 per QALY. In sensitivity analyses, screening remained cost-effective across a wide range of ages at screening, costs of screening, costs of treatment, and probabilities of adverse outcomes. The results were most influenced by the cost and utility of low IQ in the offspring. At annual costs of $3,648 for care of each child with IQ[]85, screening became cost-saving.

CONCLUSIONS: Screening pregnant women for autoimmune thyroid disease is cost-effective compared with other well-accepted screening practices, and becomes cost-saving at higher costs of care for children with a low IQ. The medical community should strongly consider screening women with anti-TPO antibodies in the first trimester of pregnancy.