Subject(s)
Congenital Abnormalities/diagnostic imaging , Congenital Hypothyroidism/diagnostic imaging , Child , Child, Preschool , Comorbidity , Congenital Abnormalities/economics , Congenital Abnormalities/epidemiology , Congenital Hypothyroidism/economics , Congenital Hypothyroidism/epidemiology , Humans , Kidney/abnormalities , Kidney/diagnostic imaging , Risk , Ultrasonography/economicsABSTRACT
CONTEXT: Since the introduction of screening for congenital hypothyroidism (CH) in 1974, the optimal laboratory strategy has been the subject of debate. OBJECTIVE: To assess the clinical effectiveness and cost-effectiveness of various types of thyroxine (T(4))-based strategies to screen for CH. DESIGN, SETTING, AND PARTICIPANTS: In the Netherlands, since January 1, 1995, a primary T(4) determination with supplemental thyroid-stimulating hormone (TSH) and T(4)-binding globulin (TBG) measurements has been used. Results were calculated from cumulative findings for 1181079 children screened between January 1, 1995, and December 31, 2000. MAIN OUTCOME MEASURES: Rates of detection of patients with CH of thyroidal origin (CH-T) or CH of central origin (CH-C), false-positive rates, laboratory costs, and costs of initial diagnostic evaluations. RESULTS: All known infants (n = 393) with CH-T and 92% (n = 66) of infants with CH-C were detected on the basis of low T(4) levels, TSH elevation, and/or low T(4)/TBG ratios. If the decision to refer had been based solely on TSH elevation, then 94% of patients with CH-T and none of the patients with CH-C would have been detected. If low T(4) levels (Subject(s)
Congenital Hypothyroidism/diagnosis
, Neonatal Screening
, Thyroxine-Binding Proteins/analysis
, Thyroxine/blood
, Congenital Hypothyroidism/economics
, Congenital Hypothyroidism/etiology
, Cost-Benefit Analysis
, Costs and Cost Analysis
, False Positive Reactions
, Humans
, Infant, Newborn
, Neonatal Screening/economics
, Netherlands
, Predictive Value of Tests
, Sensitivity and Specificity
, Thyrotropin/blood