Cost-effectiveness of prenatal screening for postpartum thyroiditis

Area of Science:

• Endocrinology
• Reproductive Health
• Health Economics

Background:

• Postpartum thyroiditis (PPT) affects 5% of pregnant women and 25% of those with insulin-dependent diabetes mellitus (IDDM).
• PPT can be predicted prenatally via thyroid peroxidase (TPO) antibody presence, indicating potential for early intervention.
• Current screening strategies lack prenatal TPO antibody testing, potentially delaying diagnosis and management.

Purpose of the Study:

• To evaluate the cost-effectiveness of prenatal TPO antibody screening for PPT.
• To compare TPO antibody screening with no screening and postpartum thyroid-stimulating hormone (TSH) testing.
• To analyze screening costs, medical outcomes, and quality-adjusted life years (QALYs) for different strategies.

Main Methods:

• A decision tree model was utilized for cost-effectiveness analysis.
• Hypothetical cohorts of 1000 women (uncomplicated and IDDM pregnancies) were simulated.
• Direct medical costs, QALYs, and detected PPT cases were determined for each strategy.

Main Results:

• Postpartum TSH screening cost $75,000 per 1000 women, yielding 995.2 QALYs ($48,000/QALY).
• Prenatal TPO antibody screening cost $93,000 per 1000 women, yielding 995.5 QALYs ($60,000/QALY).
• For women with IDDM, TSH screening yielded an incremental cost-effectiveness ratio (ICER) of $13,000/QALY, and TPO antibody screening had an ICER of $32,000/QALY.

Conclusions:

• Prenatal TPO antibody screening for PPT is a reasonably cost-effective strategy.
• Screening offers improved health outcomes and should be considered for routine prenatal care.
• The cost-effectiveness is sensitive to test accuracy, disease incidence, and symptomatic presentation rates.