Artikel
Cost-effectiveness analysis of prevention of iodine deficiency disorders
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Autoren
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Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Monika Schaffner
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Nikolai Mühlberger
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Vjollca Qerimi Rushaj
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Faculty of Pharmacy, School of PhD Studies, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
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Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Igor Stojkov
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Eftychia Koukkou
- Department of Endocrinology, University of Patras, Patras, Greece
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Betina Heinsbæk Thuesen
- Centre for Clinical Research and Prevention, Capital Region of Denmark, Hillerod, Denmark
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Petra Schnell-Inderst
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Wilhelm Oberaigner
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, United States of America; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| Veröffentlicht: | 6. September 2019 |
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Gliederung
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Background: Iodine deficiency can have severe consequences on a population’s health (e.g., increased incidence of goiter, stillbirth and thyroid nodules) with substantial health economic burden. Our project was part of EUthyroid, an EU Horizon 2020 project, “aimed at overcoming the negative health effects associated with iodine deficiency”. However, a population-based prevention program for iodine deficiency might also harm persons, for example, by increasing hyperthyroidism. Decision-analytic modeling is frequently applied in health economic evaluation to weigh long-term benefits and harms, and economic consequences. Our aim was to apply a decision-analytic model to evaluate the long-term effectiveness and cost effectiveness of a population based prevention program for iodine deficiency disorders (IDD) in a moderately iodine deficient population.
Methods: We developed a dynamic state-transition population model to project the health and economic consequences of an IDD prevention program in a hypothetical population with moderate iodine deficiency in the German setting. The modeled target population consists of the current German population and future generations over a time horizon of 120 years. We compared prevention with iodine fortification of salt with no such prevention. Model parameters were derived by literature reviews, experts’ estimations or model calibration methods. The model was evaluated from a German societal perspective. Costs included direct medical and non-medical costs and are reported in 2018 Euros. We evaluated incremental life years (LY), incremental quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICER) for the comparison of prevention versus no prevention. Health effects and costs were discounted at 3% annually. Model validation was performed for face validity, internal validity and external validity.
Furthermore, we performed two closed cohort scenario analyses: (1) We followed a newborn cohort over their lifetime and (2) we evaluated a currently alive population over their lifetime. To evaluate the robustness of our results when varying model parameter values, we performed extensive one-way sensitivity analyses.
Results: Our analysis resulted in a slightly higher discounted (quality-adjusted) life expectancy with the prevention program compared to no prevention (26.99 versus 26.98 LYs, 26.80 versus 26.72 QALYs). These values represent the ratio between the cumulative outcomes (LYs and QALYs) "gathered" by members of the dynamic population (including the initial population and their offsprings) over a 120 year time period divided by the number of persons of the initial population. Cumulative means this measure includes the benefit of the index person of the dynamic population and the outcomes of their offsprings in 120 years. The prevention program results in fewer costs than the no prevention strategy (2,987 versus 6,726 Euro per person of the initial cohort). Thus, the prevention strategy is dominant (i.e., more effective and cost-saving) compared to no prevention. The prevention program was also dominant in the scenario analyses and in most of the sensitivity analyses.
Conclusions: We showed that prevention of IDDs for a moderately iodine deficient population is a recommendable public health intervention. However, a mandatory prevention program might also harm individual persons by introducing more cases of hyperthyroidism while leading to an overall gain in health.
Acknowledgments: 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. This work was financially supported through Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission. Henry Völzke reports lecture honorarium from Sanofi.
The authors declare that a positive ethics committee vote has been obtained.
