Decision-Analytic Modeling Studies in Prevention and Treatment of Iodine Deficiency and Thyroid Disorders: A Systematic Overview

Rochau, Ursula; Rushaj, Vjollca Qerimi; Schaffner, Monika; Schönhensch, Marie; Stojkov, Igor; Jahn, Beate; Hubalewska-Dydejczyk, A.; Erlund, Iris; Thuesen, Betina Heinsbæk; Zimmermann, Michael; Moreno‐Reyes, Rodrigo; Lazarus, John; Völzke, Henry; Siebert, Uwe

doi:10.1089/thy.2018.0776

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…Iodine is necessary for the synthesis of thyroid hormones, such as triiodothyronine and tetraiodothyronine, which are essential for all aspects of human metabolism (1,2) . Chronic iodine deficiency can lead to iodine deficiency disorders, which may adversely affect the physical and mental development of people of all ages (3) . Iodised salt has been introduced in many countries, including Switzerland, Sweden, Croatia, Italy, Spain, Mongolia and China, as a safe, cost-effective and sustainable way to eliminate iodine deficiency disorders (4)(5)(6) .…”

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confidence: 99%

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

et al. 2020

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As city residents eat out more frequently, it is unknown that if iodised salt is still required in home cooking. We analysed the relationship of household salt and eating out on urinary iodine concentration (UIC) in pregnant women. A household condiment weighing method was implemented to collect salt data for a week. A household salt sample was collected. A urine sample was taken at the end of the week. Totally, 4640 participants were investigated. The median UIC was 139·1 μg/l in pregnant women and 148·7, 140·0 and 122·9 μg/l in the first, second and third trimesters. Median UIC in the third trimester was lower than in the other trimesters (P < 0·001). The usage rates of iodised (an iodine content ≥ 5·0 mg/kg) and qualified-iodised (an iodine content ≥ 21·0 mg/kg) salt were 73·9 and 59·3 %. The median UIC in the qualified-iodised salt group was higher than in the non-iodised group (P = 0·037). The median UIC in the non-iodised group who did not eat out was lower than in qualified-salt groups who both did and did not eat out (P = 0·007, <0·001). The proportion of qualified-iodised salt used in home cooking is low, but foods eaten out have universal salt iodisation according to the national compulsory policy. Household iodised salt did not play a decisive role in the iodine status of pregnant women. Pregnant women in their third trimester who are not eating out and using non-iodised salt at home require extra iodine.

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confidence: 99%

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

et al. 2020

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“…fortification of salt for the German population with moderate iodine deficiency. To date, no decision-analytic model evaluating the full impact of a population-based approach for IDD prevention has been published (6). Based on our decision analysis, we found that the implementation of the IDD prevention program yields an increase both in QALYs and life years.…”

Section: Discussionmentioning

confidence: 75%

“…There are several studies on the efficacy of IDD prevention programs (2,5). However, to our knowledge, there is no public health study available, investigating the long-term effectiveness of IDD prevention programs including all patient-relevant outcomes, such as avoided IDDs or quality of life (6). The empirical evidence on the effectiveness of population-based programs for primary prevention is limited.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, comprehensive benefit/harm analyses considering the full effects of a population-wide IDD prevention program on the population's life expectancy and quality of life are lacking (6). Therefore, the aim of this public health assessment was to develop a decision-analytic model (10,12) to evaluate the long-term population net benefit of a mandatory IDD prevention program for the German population, as a case example for a European country with moderate iodine deficiency.…”

Section: Introductionmentioning

confidence: 99%

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

Schaffner

Mühlberger

Conrads-Frank

et al. 2021

Thyroid

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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.

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“…Rochau e colleghi [11] hanno sviluppato un modello di coorte aperto state-transition allo scopo di prevedere le conseguenze sanitarie ed economiche del programma di prevenzione delle IDD basato sulla fortificazione del sale con iodio. Il modello è stato sviluppato per un'ipotetica popolazione tedesca con carenza iodica moderata.…”

Section: Risultati DI Euthyroidunclassified

I disordini da carenza nutrizionale di iodio in Europa: aggiornamento 2019

Lazarus

2020

L'Endocrinologo

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SommarioIl gozzo endemico in Europa è riconosciuto da diversi secoli e la carenza nutrizionale di iodio (IDD) è nota da più di 150 anni. L’impatto della IDD sullo sviluppo del sistema nervoso e particolarmente sul quoziente intellettivo (QI) e sul rendimento scolastico dei bambini è stato documentato negli ultimi 40 anni ma i Ministeri della Salute hanno dedicato scarsa attenzione al problema e, di conseguenza, il consumo di sale fortificato con iodio in Europa è molto variabile. L’Unione Europea ha finanziato un ulteriore progetto Horizon 2020 per valutare la discrepanza nelle misurazioni dello iodio, determinare il ruolo della tireoglobulina circolante quale marcatore di IDD in gravidanza e studiare lo stato di nutrizione iodica combinando i risultati di tre grandi studi di coorte in Spagna, Regno Unito e Paesi Bassi. In aggiunta è stato sviluppato un modello di coorte aperta “state-transition”, finalizzato a prevedere le conseguenze sanitarie ed economiche di un programma di prevenzione delle IDD. Tale analisi ha concluso per il positivo costo/beneficio dell’uso del sale fortificato con iodio quale misura preventiva contro l’IDD in una popolazione moderatamente iodo-deficiente, quale quella residente in Europa. È auspicabile che la dichiarazione di Cracovia possa sostenere future politiche di implementazione a livello dei Ministeri della Salute.

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Decision-Analytic Modeling Studies in Prevention and Treatment of Iodine Deficiency and Thyroid Disorders: A Systematic Overview

Cited by 8 publications

References 35 publications

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

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

I disordini da carenza nutrizionale di iodio in Europa: aggiornamento 2019

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