ABSTRACT
OBJECTIVE: Untreated maternal hypothyroidism during pregnancy can have adverse consequences on maternal health and child intelligence quotient (IQ). Our objective was to examine the cost-effectiveness of screening pregnant women for autoimmune thyroid disease. DESIGN: We developed a state-transition Markov model and performed a cost-effectiveness analysis of screening pregnant US women, aged 15-45 years, with no known history of thyroid disease, in the first trimester. METHODS: Three strategies were compared: 1) no screening, 2) one-time screening using anti-thyroid peroxidase (anti-TPO) antibodies, and 3) one-time screening using TSH. Screening tests were added to the laboratory tests of the first prenatal visit. Abnormal screening tests were followed by further testing and subsequent thyroxine treatment of hypothyroid women. RESULTS: Screening pregnant women in the first trimester using TSH was cost-saving compared with no screening. Screening using anti-TPO antibodies was cost-effective compared with TSH screening with an incremental cost-effectiveness ratio of $15,182 per quality-adjusted life year. Screening using TSH remained cost-saving across a wide range of ages at screening, costs of treatment, and probabilities of adverse outcomes. The cost-effectiveness of anti-TPO screening compared with TSH screening was mostly influenced by the probability of diagnosing hypothyroidism in unscreened subjects or subjects with a normal screening test. Screening remained highly cost-effective in scenarios where we assumed no improvement of child IQ outcomes by levothyroxine treatment. CONCLUSION: Screening all pregnant women for autoimmune thyroid disease in the first trimester is cost-effective compared with not screening.
Subject(s)
Autoimmune Diseases/diagnosis , Mass Screening/economics , Thyroid Diseases/diagnosis , Adolescent , Adult , Autoimmune Diseases/metabolism , Cost-Benefit Analysis/methods , Female , Humans , Iodide Peroxidase/metabolism , Markov Chains , Mass Screening/methods , Middle Aged , Models, Economic , Pregnancy , Pregnancy Trimester, First , Thyroid Diseases/metabolism , Thyrotropin/metabolismABSTRACT
PURPOSE: Preferences are known to vary by individuals' personal experience with a health state, but variation among respondents' scoring of the same hypothetical state is unproven but relevant to the use of community-perspective preference scores. This research explored the systematic contribution of respondents' age, race and gender to variability in community perspective preferences for hypothetical health states. METHODS: Data from four community samples were pooled for the analysis. Linear regression modeling was used to test for the effect of respondent age, race and gender on preference scores while controlling for health state severity. RESULTS: In this sample of 956 preference scores from 390 individuals across 4 studies, older respondents provided lower preference scores for the same hypothetical health state compared with younger respondents (regression coefficient for 1 year of age = -0.002, p < 0.001), and white individuals provided higher preference scores for the same states compared with non-white individuals (regression coefficient = 0.056, p = 0.014). CONCLUSION: Preferences for hypothetical health states may vary by the age and race of the respondent providing the score. Community-perspective preferences should thus be elicited from large, random samples of the relevant population to ensure variation on these as well as other yet-unidentified characteristics that may affect scores.
Subject(s)
Attitude to Health , Consumer Behavior/statistics & numerical data , Health Status , Quality of Life , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Quality-Adjusted Life Years , Racial Groups , Sex Factors , Sickness Impact Profile , Social PerceptionABSTRACT
PURPOSE: To evaluate the cost-effectiveness of positron emission tomography (PET) in the diagnosis of Alzheimer disease (AD) in community-dwelling patients with mild or moderate dementia who present to specialized AD centers. MATERIALS AND METHODS: A decision-analytic model was used to compare costs and quality-adjusted life years (QALYs) associated with strategies involving single photon emission computed tomography (SPECT), dynamic susceptibility-weighted contrast material-enhanced magnetic resonance (MR) imaging, and PET as functional imaging adjuncts to the standard clinical work-up. Sensitivity analyses were performed to examine changes in test characteristics, health-related quality-of-life survey instruments, therapeutic effectiveness, and treatment rules. RESULTS: The use of PET to confirm the results of the standard clinical work-up cost more but yielded fewer benefits than a strategy in which dynamic susceptibility-weighted contrast-enhanced MR imaging was substituted for the typically performed structural computed tomography. This relationship remained stable in scenarios in which standard diagnostic work-up accuracy, drug treatment effectiveness, and version of the Health Utilities Index were altered. Dynamic susceptibility-weighted contrast-enhanced MR imaging cost US dollars 598800 per QALY gained (range, US dollars 74400 to US dollars 1.9 million per QALY), compared with the cost of the standard diagnostic work-up. Treating all patients with dementia was the dominant imaging strategy, except when side effects in patients with non-AD-related dementia were modeled. In all scenarios, SPECT yielded fewer benefits than other strategies at a higher cost. CONCLUSION: PET may have high diagnostic accuracy, but adding it to the standard diagnostic regimen at AD clinics would yield limited, if any, benefits at very high costs.
