Abstract
Objective:
The value of early detection of subclinical hypothyroidism is the object of a long lasting debate. In this study, we assessed the cost effectiveness of a policy based upon screening for this condition through thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) serum level measurements in the elderly.
Design:
A Markov model was developed where hypothetical elderly patients (i.e. ≥60 years of age), who attend general practitioner (GP) clinics for periodic health examinations in a primary-care setting in Italy, made transitions between health states at annual intervals for 15 years, thus allowing an estimation of the average cost and of the expected average number of quality-adjusted life-years (QALY). In this model, patients were assumed to be seen at annual intervals by GPs for clinical examination and serum cholesterol level measurement, to which a TSH, T3 and T4 serum measurement was added. In the base-case analysis, TSH was measured every 5 years and, if abnormal, T3 and T4 serum levels were also determined. Costs were analysed from the perspective of the Italian National Health Service (NHS) and reflected 1996 values.
Main outcome measures and results:
In the base-case analysis, the additional benefit estimated from testing a female population for subclinical hypothyroidism every 5 years was 0.36 QALY, with a cost per QALY gained of 668 298 lire (L). The expected gain in QALY for men was 0.20 and the cost per QALY gained was L270 322. In general, the best cost-effectiveness profile was seen with testing every 3 years.
Results were sensitive to variations in the prevalence of disease among the target population, both in men and women.
Conclusions:
Our study indicates that a screening policy for subclinical hypothyroidism in the elderly population could be worthwhile. However, as the costs could be significant when applied at the population level, this policy deserves further assessment through well-designed primary research.
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References
Surks MI, Ocampo E. Subclinical thyroid disease. Am J Med 1996; 100: 217–23
Wiersinga WM. Subclinical hypothyroidism and hyperthyroidism. I: prevalence and clinical relevance. Neth J Med 1995; 46: 197–204
Bemben DA, Winn P, Hamm RM, et al. Thyroid disease in the elderly. Part I: prevalence of undiagnosed hypothyroidism. J Fam Pract 1994; 38: 577–82
Bemben DA, Hamm RM, Morgan L, et al. Thyroid disease in the elderly. Part 2: predictability of subclinical hypothyroidism. J Fam Pract 1994; 38: 583–8
Vanderpump MPJ, Tunbridge WMG, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf) 1995; 43: 55–68
Geul KW, van Sluisveld ILL, Grobbee DE, et al. The importance of thyroid microsomal antibodies in the development of elevated serum TSH in middle-aged women: associations with serum lipids. Clin Endocrinol (Oxf) 1993; 39: 275–80
Tunbridge WMG, Brewis M, French JM, et al. Natural history of autoimmune thyroiditis. BMJ 1981; 282: 258–62
Rosenthal MJ, Hunt WC, Garry PJ, et al. Thyroid failure in the elderly. JAMA 1987; 258: 209–13
Zazove P. Should we screen for hypothyroidism in the elderly? J Fam Pract 1994; 38: 571–3
US Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore (MD): Williams & Wilkins, 1996
Screening for thyroid disease. Lancet 1981; II: 128–30
Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979; 121: 1–45
Helfand M, Crapo LM. Screening for thyroid disease. Ann Intern Med 1990; 112: 840–9
Singer PA, Cooper DS, Levy EG, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. JAMA 1995; 273: 808–12
Althaus BU, Staub JJ, Ryff-De Leche A, et al. LDL/HDL changes in subclinical hypothyroidism: possible risk factors for coronary heart disease. Clin Endocrinol (Oxf) 1988; 28: 157–63
Caron P, Calazel C, Parra HJ, et al. Decreased HDL cholesterol in subclinical hypothyroidism: the effect of L-thyroxine therapy. Clin Endocrinol (Oxf) 1990; 33: 519–23
Arem R, Patsch W. Lipoprotein and apolipoprotein levels in subclinical hypothyroidism: effect of levothyroxine therapy. Arch Intern Med 1990; 150: 2097–100
Weetman AP. Hypothyroidism: screening and subclinical disease. BMJ 1997; 314: 1175–8
Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making 1983; 3: 419–58
Danese MD, Powe NR, Sawin CT, et al. Screening for mild thyroid failure at the periodic health examination: a decision and cost-effectiveness analysis. JAMA 1996; 276: 285–92
Tanis BC, Westendorp RGJ, Smeit AHM. Effect of thyroid substitution on hypercholesterolemia in patients with subclinical hypothyroidism: a reanalysis of intervention studies. ClinEndocrinol (Oxf) 1996; 44: 643–9
Anderson KM, Wilson PWF, Odell PM, et al. An updated coronary risk profile: a statement for health professionals. Circulation 1991; 83: 356–62
Eggertsen R, Petersen K, Lundberg P-A, et al. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. BMJ 1988; 297: 1586–92
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Bona, M., Santini, F., Rivolta, G. et al. Cost Effectiveness of Screening for Subclinical Hypothyroidism in the Elderly. Pharmacoeconomics 14, 209–216 (1998). https://doi.org/10.2165/00019053-199814020-00009
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DOI: https://doi.org/10.2165/00019053-199814020-00009