Artikel
A Decision-Analytic Model to Evaluate Benefits and Harms of a Prevention Program for Iodine Deficiency Disorders
Suche in Medline nach
Autoren
Veröffentlicht: | 20. März 2019 |
---|
Gliederung
Text
Background/research question: Iodine deficiency (ID) is one of the most prevalent causes of mental development disorders in children and can lead to impaired thyroid function and other iodine deficiency disorders (IDDs). Despite the progress that has been made in the eradication of ID in the last decades in Europe, IDDs, such as goiter and thyroid nodules, are still prevalent. Currently, evidence-based information is lacking on the burden of ID in Europe and the benefit-harm ratio of an IDD prevention program in European countries. We developed a decision-analytic model to evaluate the long-term net benefit of an IDD prevention program for the German population with hypothetical moderate ID, as an example for a European country.
Methods: We developed a decision-analytic state-transition cohort model simulating the incidence and consequences of IDDs in the absence or presence of an IDD prevention program (iodine fortification of salt) in a dynamic population with current demographic characteristics in Germany and with moderate ID. We collected data on prevalence, incidence, mortality, and utilities (quality-of-life indices) from different European studies for all possible health states within the model. Our primary net-benefit outcome was gains in quality-adjusted life years (QALYs) predicted over a time horizon of 120 years. Additionally, we calculated incremental life years and cumulative disease events over time. We conducted multiple deterministic one-way sensitivity analyses to evaluate the influence of uncertain parameters.
Results: In the base-case analysis, the IDD prevention program is more beneficial than no prevention, both in terms of QALYs and life years. Undiscounted health gains predicted for the dynamic cohort are 33.3 million QALYs and 5 million life years, respectively, over a time horizon of 120 years for the German population (82.2 million inhabitants). 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 with iodine fortification of salt increases quality-adjusted life expectancy in a European population with moderate ID and thus is beneficial. However, ethical aspects, such as the autonomy of the individuals, should be considered before implementing a mandatory IDD prevention program. Costs for prevention and therapy of IDDs should be included in the decision-analytic model to evaluate cost-effectiveness of IDD prevention.
Competing interests: This work was supported by EUthyroid. The project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 634453.