Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España

Candil, Sergio Donnay; Barro, José Antonio Balsa; Hernández, Julia Álvarez; Crespo, C.; Pérez-Alcántara, F.; Sánchez, Carlos Polanco

doi:10.1016/j.endonu.2015.03.007

Cited by 20 publications

(7 citation statements)

References 19 publications

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“…Another important point in public screening is cost-effectiveness; if the usefulness of a screening model is definitively proven, women’s global screening in the first trimester appears to be cost-effective [ 76 – 78 ]. A study by Dosiou et al [ 79 ] demonstrated the cost-effectiveness of universal screening of pregnant women with anti-TPO Ab and TSH antibodies in the first trimester of pregnancy compared to a high-risk screening strategy. Based on sensitivity analyses, even when the benefits of screening were limited to the diagnosis and treatment of overt hypothyroidism, screening was very cost-effective at less than $8000/quality-adjusted life-year [ 80 ].…”

Section: Discussionmentioning

confidence: 99%

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

Sepasi

Rashidian

Shokri

et al. 2020

BMC Pregnancy Childbirth

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Background: Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and fetus. The present meta-analysis was conducted to evaluate thyroid dysfunction in Iranian pregnant women. Methods: We registered this review at PROSPERO (registration number: CRD42020166655). The research steps in this systematic review and meta-analysis were performed according to the MOOSE protocol, and finally, reports were provided based on the PRISMA guidelines. The literature search was performed in October 2019 using the international online databases, including Web of Science, Ovid, Science Direct, Scopus, EMBASE, PubMed/Medline, Cochrane Library, EBSCO, CINAHL, Google Scholar as well as national databases were reviewed. Data were extracted after applying the inclusion and exclusion criteria and qualitative evaluation of the studies. I 2 index and Q test were used to assess differences in studies. All analyses were performed using Comprehensive Meta-Analysis Software. Pvalue less than 0.05 was considered statistically significant. We identified 1261 potential articles from the databases, and 426 articles remained after removing the duplicate and unrelated studies. After evaluating the full text, 52 articles were removed. Results: Finally, 19 eligible studies including 17,670 pregnant women included for meta-analysis. The prevalence of thyroid dysfunction in Iranian pregnant women was 18.10% (95%CI: 13.89-23.25). The prevalence of hypothyroidism, clinical hypothyroidism, and subclinical hypothyroidism in Iranian pregnant women was respectively estimated to be 13.01% (95%CI: 9.15-18.17), 1.35% (95%CI: 0.97-1.86) and 11.90% (95%CI: 7.40-18.57). The prevalence of hyperthyroidism, clinical hyperthyroidism, and subclinical hyperthyroidism in Iranian pregnant women was respectively estimated to be 3.31% (95%CI: 1.62-6.61), 1.06% (95%CI: 0.61-1.84) and 2.56% (95%CI: 0.90-7.05). The prevalence of anti-thyroperoxidase antibody was estimated to be 11.68% (95%CI: 7.92-16.89). Conclusion: The results of this meta-analysis showed a high prevalence of thyroid disorders, especially hypothyroidism. The decision to recommend thyroid screening during pregnancy for all women is still under debate, because the positive effects of treatment on pregnancy outcomes must be ensured. On the other hand, evidence about the effect of thyroid screening and treatment of thyroid disorders on pregnancy outcomes is still insufficient. Nevertheless, a large percentage of general practitioners, obstetricians and gynecologists perform screening procedures in Iran.

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Section: Discussionmentioning

confidence: 99%

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

Sepasi

Rashidian

Shokri

et al. 2020

BMC Pregnancy Childbirth

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“…In the USA, analysis for cost-effectiveness has demonstrated that for every 100,000 pregnant women screened for SCH, $8,356,383 is saved, and 589.3 QALYs (marginal cost per quality-adjusted life year) are gained (31). Another study also reported that universal screening instead of high risk screening would result in an annual saving of €2,653,854 for the Spanish National Health System (32). The findings of this study suggest that if pregnancy is planned, universal screening should ideally be performed in the preconception period.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy

Liu

Wang

et al. 2019

Front. Endocrinol.

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Subclinical hypothyroidism (SCH) is a mild form of hypothyroidism that is common among women of childbearing age. The impact of SCH on adverse perinatal outcomes is unclear and universal screening for thyroid function before or during pregnancy is also much debated. In the present retrospective cohort study on 7,587 women from Shanghai, we assessed whether SCH was associated with adverse perinatal outcomes. The relationship between the risks of adverse outcomes and the time of screening and LT4 treatment status for SCH were also evaluated. SCH was associated with hypertensive disorders of pregnancy (HDP) [odds ratio (OR): 4.04; 95% confidence interval (CI): 1.85–8.84; P = 0.000]. After classification into four different groups based on the time of screening for thyroid function, the increased likelihood of HDP persisted in those diagnosed with SCH in the first and second trimesters (OR: 9.69; 95% CI: 1.73–54.48; P = 0.01 and OR: 3.66; 95% CI: 1.07–12.57, P = 0.03, respectively). The diagnosis of SCH in the preconception period and the third trimester was not significantly associated with HDP and other adverse perinatal outcomes. Five out of 120 (5/120) treated women (4.17%) vs. 4/45 untreated women (8.89%) developed HDP, 4/5 were treated after conception. The results indicate that during pregnancy, SCH conferred an increased risk of HDP, particularly in women diagnosed with the disorder in the first and second trimesters.

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“… 37 In Spain, screening patients at both high and low risk for thyroid disease proved to be more cost effective compared to no screening and screening only high-risk patients. 38 Data on the subject in Saudi Arabia is lacking, and longitudinal studies on the cost-effectiveness of implementing universal screening for SCH in pregnancy in Saudi Arabia are needed to further evaluate whether universal screening in Saudi Arabia is justified.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia

Shanqeeti

Alkhudairy

Alabdulwahed

et al. 2018

SMJ

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objectives:To estimate the prevalence of subclinical hypothyroidism (SCH) in Saudi Arabia and assess the need for an SCH screening program.Methods:This cross-sectional study was conducted at King Abdulaziz Medical City and the Khashmulaan Clinic at the National Guard Health Affairs, Riyadh, Saudi Arabia in August 2016. All women attending the antenatal clinics were invited to participate in the study. In addition, data were retrieved from the files of pregnant women who had been screened for hypothyroidism from January 2016 to August 2016. A total of 384 pregnant women were included in the study.Results:The prevalence of SCH in pregnant women in this study was 50/384 (13%) with 95% confidence intervals (CIs): 9.82%-16.80%. Pregnant women who were randomly screened using a survey (n=127) were 3 times more likely (OR: 3.1; 95% CI: 1.182 to 8.704, p=0.022) to have SCH compared to pregnant women who were screened based on their physician’s judgement (n=257). Results showed older age (≥40 years) was associated with an insignificant decrease in the risk of SCH.Conclusion:Random screening for SCH in pregnant women showed a higher prevalence in comparison to women who were screened as a result of physician referrals. The results highlight the urgent need for larger studies to investigate the prevalence of SCH as well as the need for an SCH screening program.

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Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España

Cited by 20 publications

References 19 publications

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy

Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia

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