Benefits and Harms of a Prevention Program for Iodine Deficiency Disorders: Predictions of the Decision-Analytic EUthyroid Model

Abstract

Background: Iodine deficiency is one of the most prevalent causes of intellectual disability and can lead to impaired thyroid function and other iodine deficiency disorders (IDDs). Despite progress made on eradicating iodine deficiency in the last decades in Europe, IDDs are still prevalent. Currently, evidence-based information on the benefit/harm balance of IDD prevention in Europe is lacking. We developed a decision-analytic model and conducted a public health decision analysis for the long-term net benefit of a mandatory IDD prevention program for the German population with moderate iodine deficiency, as a case example for a European country. Methods: We developed a decision-analytic Markov model simulating the incidence and consequences of IDDs in the absence or presence of a mandatory IDD prevention program (iodine fortification of salt) in an open population with current demographic characteristics in Germany and with moderate ID. We collected data on the prevalence, incidence, mortality, and quality of life from European studies for all health states of the model. Our primary net-benefit outcome was quality-adjusted life years (QALYs) predicted over a period of 120 years. In addition, we calculated incremental life years and disease events over time. We performed a systematic and comprehensive uncertainty assessment using multiple deterministic one-way sensitivity analyses. Results: In the base-case analysis, the IDD prevention program is more beneficial than no prevention, both in terms of QALYs and life years. Health gains predicted for the open cohort over a time horizon of 120 years for the German population (82.2 million inhabitants) were 33 million QALYs and 5 million life years. Nevertheless, prevention is not beneficial for all individuals since it causes additional hyperthyroidism (2.7 million additional cases). Results for QALY gains were stable in sensitivity analyses. Conclusions: IDD prevention via mandatory iodine fortification of salt increases quality-adjusted life expectancy in a European population with moderate ID, and is therefore beneficial on a population level. However, further ethical aspects should be considered before implementing a mandatory IDD prevention program. Costs for IDD prevention and treatment should be determined to evaluate the cost effectiveness of IDD prevention.

Essentiality of Trace Elements in Pregnancy, Fertility, and Gynecologic Cancers—A State-of-the-Art Review

“…Iodine deficiency exerts multiple adverse effects on growth and development that are preventable [ 200 ]. Fifty percent of Europe is still slightly iodine deficient, while iodine intakes in other developed nations, like the United States and Australia, have decreased in recent years by introducing iodized salt; the FDA has approved the use of potassium iodide and cuprous iodide for salt iodization [ 201 , 202 ]. Iodine deficiency disorders are listed under specialized criteria relating to infertility and are associated with abortions, stillbirths, and congenital anomalies [ 200 , 203 ], this being a tender subject for unexplained circumstances.…”

Variazioni epidemiologiche delle neoplasie tiroidee nel tempo: ruolo della nutrizione iodica

“…Le politiche che mirano a promuovere la nutrizione iodica hanno dimostrato, in uno studio europeo, di aumentare l'aspettativa di vita (corretta per la qualità di vita) nelle aree iodo-carenti, a livello di popolazione [7]. Esse possono ridurre l'incidenza e la prevalenza del gozzo (e forse alcune forme di patologia nodulare tiroidea), ma non sembrano esercitare un ruolo significativo nella riduzione del rischio di carcinoma tiroideo.…”

Comparison between an Emerging Point-of-Care Tool for TSH Evaluation and a Centralized Laboratory-Based Method in a Cohort of Patients from Southern Italy

“…The most serious complication of congenital iodine deficiency is endemic cretinism, characterized by severe mental retardation, neurological symptoms, and/or hypothyroidism [19]. In addition, iodine deficiency negatively affects quality of life and economic productivity [20]. In the last decades, iodine prophylaxis programs, which are based on salt or water iodization and implemented by the World Health Organization and in Italy (Law No.…”

“…The most serious complication of congenital iodine deficiency is endemic cretinism, characterized by severe mental retardation, neurological symptoms, and/or hypothyroidism [ 19 ]. In addition, iodine deficiency negatively affects quality of life and economic productivity [ 20 ].…”

“…In the last decades, iodine prophylaxis programs, which are based on salt or water iodization and implemented by the World Health Organization and in Italy (Law No. 55/2005), have not only decreased the prevalence of iodine deficiency disorders but have also caused major changes in the steady pattern of thyroid disorders; these are characterized by an increased prevalence of autoimmune thyroid disease, ranging from atrophic to goitrous Hashimoto’s thyroiditis, Graves’ hyperthyroidism, non-autoimmune hyperthyroidism, and autonomous thyroid nodules [ 9 , 20 , 21 , 22 ]. Thus, thyroid dysfunction still remains a problem.…”