Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Institute of Metabolic Sciences, Addenbrooke's Hospital, Cambridge, UK.
BMJ Open. 2019 Jul 29;9(7):e029369. doi: 10.1136/bmjopen-2019-029369.
We examined whether it is cost-effective to measure free thyroxine (FT4) in addition to thyrotropin (thyroid-stimulating hormone (TSH)) on all requests for thyroid function tests from primary care on adult patients.
Hypopituitarism occurs in about 4 people per 100 000 per year. Loss of thyrotropin (TSH) secretion may lead to secondary hypothyroidism with a low TSH and low FT4, and this pattern may help to diagnose hypopituitarism that might otherwise be missed.
Markov model simulation.
Incremental cost-effectiveness ratio (ICER), the ratio of cost in pounds to benefit in quality-adjusted life years of this strategy.
The ICER for this strategy was £71 437. Factors with a large influence on the ICER were the utilities of the treated hypopituitary state, the likelihood of going to the general practitioner (GP) and of the GP recognising a hypopituitary patient. The ICER would be below £20 000 at a cost to the user of an FT4 measurement of £0.61.
With FT4 measurements at their present cost to the user, routine inclusion of FT4 in a thyroid hormone profile is not cost-effective.
我们研究了在初级保健对成年患者进行甲状腺功能检测的所有请求中，除促甲状腺激素（甲状腺刺激激素（TSH））外，额外测量游离甲状腺素（FT4）是否具有成本效益。
垂体功能减退症的年发病率约为每 10 万人中有 4 人。促甲状腺激素（TSH）分泌丧失可能导致继发性甲状腺功能减退症，表现为 TSH 低和 FT4 低，这种模式可能有助于诊断垂体功能减退症，否则可能会被漏诊。
马尔可夫模型模拟。
这种策略的增量成本效益比（ICER），即该策略的成本与质量调整生命年效益的比值。
该策略的 ICER 为 71437 英镑。对 ICER 影响较大的因素是接受治疗的垂体功能减退状态的效用、去全科医生（GP）就诊的可能性以及 GP 识别垂体功能减退患者的可能性。如果 FT4 测量的使用者成本为 0.61 英镑，那么该策略的 ICER 将低于 20000 英镑。
以目前 FT4 测量的使用者成本计算，在甲状腺激素谱中常规包含 FT4 并不具有成本效益。
