Cost-Effectiveness Analysis of Universal Screening for Subclinical Hypothyroidism in Pregnancy Based on the Czech Nation-Wide Pilot Screening Program in Light of Current Evidence

Area of Science:

• Endocrinology
• Maternal Health
• Health Economics

Background:

• The Czech Republic introduced universal first-trimester thyrotropin (TSH) screening in 2023.
• Current guidelines involve selective testing for thyroid dysfunction during pregnancy.
• Subclinical hypothyroidism and thyroid autoimmunity impact pregnancy outcomes.

Purpose of the Study:

• To model the cost-effectiveness and budget impact of universal TSH screening versus current practices.
• To evaluate the incremental cost-effectiveness ratio (ICER), budget impact (BI), and endocrinology referrals (ER) for universal TSH screening.
• To assess the cost-effectiveness of extending TSH screening to include anti-thyroid peroxidase antibodies (anti-TPO).

Main Methods:

• A decision tree model was developed using evidence on levothyroxine treatment benefits and anti-TPO testing utility.
• Model parameters were derived from a national pilot screening program, including probabilities and quality-adjusted life years (QALYs).
• Economic evaluations compared outcomes against a willingness-to-pay threshold of 47,430 EUR/QALY.

Main Results:

• Universal TSH screening is projected to yield 32.9 maternal QALYs gained, prevent 65 miscarriages, and 52 preterm deliveries per 100,000 pregnancies, with an ICER of 20,035 EUR/QALY.
• The budget impact for universal TSH screening is estimated at 659,756 EUR, with 2290 new endocrinology referrals.
• Extending screening to include anti-TPO antibodies resulted in an ICER of 15,703 EUR/QALY, a BI of 1,746,486 EUR, and 6927 ER, though based on weaker evidence.

Conclusions:

• Universal TSH screening in pregnancy is cost-effective, offering modest population benefits with a low budget impact.
• Extending screening to include anti-TPO antibodies appears cost-effective but necessitates further validation due to weak evidence and significant budget implications.