Case-finding for unsuspected thyroid disease: costs and health benefits

An algorithmic test strategy was used in 5,002 hospital and clinic patients to detect unsuspected thyroid disease. The strategy eliminated redundant secondary tests; only 9.4% of patients required a T3 uptake determination and 2.7% a TSH or T3. Twenty-six cases of hypothyroidism (incidence: 0.5%) and seven cases of hyperthyroidism (incidence: 0.1%) were diagnosed. Costs of laboratory tests were analyzed in relation to health benefits. Fully allocated production and induced costs, after discounting to present value, amounted to $31,061. Health benefits were computed using a measure of quality of life derived from health status indices. Sensitivity analysis of selected patient groups demonstrated cost-effectiveness ratios ranging from $2,022 to $1,739 per quality adjusted life year.