Danese M D, Powe N R, Sawin C T, Ladenson P W
Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205-2223.
JAMA. 1996;276(4):285-92.
To estimate the cost-effectiveness of periodic screening for mild thyroid failure by measurement of serum thyroid stimulating hormone (TSH) concentration.
Cost-utility analysis using a state-transition computer decision model that accounted for case finding, medical consequences of mild thyroid failure, and costs of care during 40 years of simulated follow-up.
Periodic health examinations in offices of primary care physicians.
Hypothetical cohorts of women and men screened every 5 years during the recommended periodic examination, beginning at age 35 years.
Adding the serum TSH assay to total serum cholesterol screening was compared to cholesterol screening alone.
Discounted quality-adjusted life years (QALYs) and direct medical costs from a societal perspective.
The cost-effectiveness of screening 35-year-old patients with a serum TSH assay every 5 years was $9223 per QALY for women and $22595 per QALY for men. The cost-effectiveness became more favorable when age at first screening was increased for both sexes and was always more favorable for women than men. Reduced progression to overt hypothyroidism and relief of symptoms increased QALYs, but did not substantially reduce direct medical costs. Finding hypercholesterolemia induced by mild thyroid failure reduced direct medical costs, but did not substantially increase QALYs. The cost of a TSH assay and the importance to patients of symptoms associated with thyroid failure were the most influential factors in sensitivity analyses.
The cost-effectiveness of screening for mild thyroid failure compares favorably with other generally accepted preventive medical practices. Physicians should consider measuring serum TSH concentration in patients aged 35 years and older undergoing routine periodic health examinations. The cost-effectiveness of screening is most favorable in elderly women.
通过测量血清促甲状腺激素（TSH）浓度来评估定期筛查轻度甲状腺功能减退的成本效益。
采用状态转换计算机决策模型进行成本效用分析，该模型考虑了病例发现、轻度甲状腺功能减退的医学后果以及模拟随访40年期间的护理成本。
基层医疗医生办公室的定期健康检查。
假设队列的女性和男性从35岁开始，每5年在推荐的定期检查时进行筛查。
将血清TSH检测添加到总血清胆固醇筛查中，并与单独的胆固醇筛查进行比较。
从社会角度计算的贴现质量调整生命年（QALY）和直接医疗成本。
每5年对35岁患者进行血清TSH检测的成本效益，女性为每QALY 9223美元，男性为每QALY 22595美元。当男女首次筛查年龄增加时，成本效益变得更有利，并且女性始终比男性更有利。进展为明显甲状腺功能减退的减少和症状缓解增加了QALY，但并未大幅降低直接医疗成本。发现由轻度甲状腺功能减退引起的高胆固醇血症降低了直接医疗成本，但并未大幅增加QALY。TSH检测成本以及甲状腺功能减退相关症状对患者的重要性是敏感性分析中最具影响力的因素。
筛查轻度甲状腺功能减退的成本效益与其他普遍接受的预防性医疗实践相比具有优势。医生应考虑对35岁及以上接受常规定期健康检查的患者测量血清TSH浓度。筛查的成本效益在老年女性中最为有利。
