Value in health regional issues · 2025
Cost-Effectiveness Analysis of Universal Screening for Subclinical Hypothyroidism in Pregnancy Based on the Czech Nation-Wide Pilot Screening Program in Light of Current Evidence.
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Tužil Jan, Jiskra Jan, Koudelková Marcela, Chloupková Renata, Hejcmanová Kateřina, Májek Ondřej, Tužilová Klára, Bartáková Jana
Аннотация
OBJECTIVES: In 2023, the Czech Guideline by Endocrinology society introduced universal screening of thyrotropin (TSH) in the first trimester of pregnancy. We modeled the incremental cost-effectiveness ratio (ICER), budget impact (BI), and new endocrinology referrals (ER) for universal screening of (1) TSH for subclinical hypothyroidism compared with the current testing and (2) extension to anti-thyroid peroxidase antibodies (anti-TPO).
METHODS: A decision tree was built assuming that levothyroxine reduces the risks of gestational hypertension, miscarriage, and preterm birth and anti-TPO test improves diagnosis of postpartum thyroiditis. Models were parametrized using the best available evidence, probabilities, and utilities from the national pilot screening program. ICER was compared with a willingness-to-pay threshold of 47 430 EUR per quality-adjusted life year (QALY).
RESULTS: Expecting 100 000 pregnancies yearly, introduction of universal TSH screening will result in 32.9 (-40 to 91.7) maternal QALYs gained, 65 (45-90) miscarriages and 52 (30-77) preterm deliveries prevented, with an ICER of 20 035 EUR/QALY (2315/3000 simulations cost-effective), the BI of 659 756 (439 993-895 993) EUR, and 2290 (1883-2728) ER (randomized-controlled-trial-level evidence). The extension of the TSH screening with anti-TPO will bring additional 111 (-398 to 604) QALY gained, ICER of 15 703 EUR per QALY (1945/3000 simulations cost-effective), the BI of 1 746 486 (1 241 391-2 350540) EUR, and 6927 (6121-7765) ER (low-level evidence).
CONCLUSIONS: Universal screening of TSH and extension with anti-TPO appear to be cost-effective. The population benefits of TSH screening are modest, but the BI is low. The model for anti-TPO is based on weak evidence and generates important BI.
METHODS: A decision tree was built assuming that levothyroxine reduces the risks of gestational hypertension, miscarriage, and preterm birth and anti-TPO test improves diagnosis of postpartum thyroiditis. Models were parametrized using the best available evidence, probabilities, and utilities from the national pilot screening program. ICER was compared with a willingness-to-pay threshold of 47 430 EUR per quality-adjusted life year (QALY).
RESULTS: Expecting 100 000 pregnancies yearly, introduction of universal TSH screening will result in 32.9 (-40 to 91.7) maternal QALYs gained, 65 (45-90) miscarriages and 52 (30-77) preterm deliveries prevented, with an ICER of 20 035 EUR/QALY (2315/3000 simulations cost-effective), the BI of 659 756 (439 993-895 993) EUR, and 2290 (1883-2728) ER (randomized-controlled-trial-level evidence). The extension of the TSH screening with anti-TPO will bring additional 111 (-398 to 604) QALY gained, ICER of 15 703 EUR per QALY (1945/3000 simulations cost-effective), the BI of 1 746 486 (1 241 391-2 350540) EUR, and 6927 (6121-7765) ER (low-level evidence).
CONCLUSIONS: Universal screening of TSH and extension with anti-TPO appear to be cost-effective. The population benefits of TSH screening are modest, but the BI is low. The model for anti-TPO is based on weak evidence and generates important BI.