Cost-benefit and effectiveness of newborn screening of congenital hypothyroidism: findings from a national program in Iran

ABSTRACT

In this study, the cost-benefit of a screening program based on the rial, the unit of currency used, was analyzed. The intelligence quotient [IQ], and height and weight were evaluated as indices for a population of children suffering from congenital hypothyroidism [CH]. The total cost for the screening program, including hormone tests, diagnosis, medicine, treatments and care was identified and calculated up to the age of seventy years and this was compared to the costs related to training and caring for patients suffering from mental retardation, who had not been screened. The screening test was done using S and S filter paper and thyroid stimulating hormone [TSH] was determined by the ELISA test. The future costs and benefits with an annual rate of 3% discount of their current value was estimated. To evaluate the effectiveness of the screening program, IQs of 32 patients were identified and compared to 36 healthy children between 2004-2005. The IQs were evaluated according to "Good Enough" and "Proteus Maze" tests. During 2008, 1165169 of 12489136 newborns [51% male, 49% female] underwent screening for CH, 92% cover-age of all newborns for that year. Four percent of recalled infants, with TSH>5 were subjected to diagnostic tests [T4, TSH, T3RU] and finally 2745 patients were identified. Benefit to cost ratios, based on a 3% annual discount rate, were 22, 41, 32, 34, 47 and 60 times lower, respectively. No significant differences were found with regard to differences in IQ scores between cases and controls [cases 105 +/- 19.3, controls 111 +/- 19.4], height [cases 106 +/- 0.7, controls 102 +/- 4.9 cm] and weight [cases 15.6 +/- 4.6, control 15.3 +/- 3.2 kg]. The national Newborn Screening [NBS] program for CH has been successful and quite effective in Iran. The method not only has economical advantages but also reduces capital expenditures and preserves normal IQ of the patients under treatment and prevents mental retardation and growth complications