The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism

Objective: The purpose of this study was to determine whether routine screening for subclinical hypothyroidism during pregnancy would be cost-effective. Study Design: We developed a decision analysis model to compare the cost-effectiveness of 2 screening strategies during pregnancy for subclinical hypothyroidism: (1) no routine screening of serum thyroid-stimulating hormone (TSH) levels (standard) and (2) routine screening of TSH levels. In the latter, women with subclinical hypothyroidism received thyroid hormone replacement. We assumed that thyroid hormone replacement could reduce the incidence of an offspring IQ < 85 for pregnancies with subclinical hypothyroidism. The main outcome measure was marginal cost per quality-adjusted life year (QALY) gained. Results: Our model predicts that universal screening is the dominant strategy. For every 100,000 pregnant women who were screened, $8,356,383 are saved, and 589.3 QALYs are gained. When subclinical hypothyroidism prevalence is reduced to 0.25%, screening remains cost-effective at $21,664/QALY gained. Conclusion: Screening for subclinical hypothyroidism in pregnancy will be a cost-effective strategy under a wide range of circumstances.