Is Universal Screening for Hypothyroidism in Pregnant Women a Cost-Effective Strategy in Indonesia and Mexico?

Speaker(s)

Ferreira A1, Tahapary DL2, González Villaseñor GA3, Maidarti M4, Albab U5, Suastika K6, Toledo JO7, Cordoba Zuñiga KE7, Kusandri A8, Masseria C9, Longo R10, Roeder C11, Dettenbach J12, Gotes Palazuelos J13, Pemayun TGD14
1Mexican Institute of Social Security, Mexico, EM, Mexico, 2Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, Indonesia, 3Chief of the department of Endocrinology of the Centro Médico Nacional de Occidente MSS, Guadalajara, JA, Mexico, 4Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, Indonesia, 5Department of Obstetrics and Gynecology Department, Pasar Rebo Regional General Hospital, Jakarta, Indonesia, Indonesia, 6Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Prof. IGNG Ngoerah Hospital, Denpasar, Indonesia, Indonesia, 7Merck Biopharma Distribution S.A. de C.V. Mexico, Mexico City, EM, Mexico, 8PT Merck Tbk., Jakarta Selatan, JK, Indonesia, 9AESARA Inc., Madrid, M, Spain, 10AESARA Inc., Corsano, Apulia, Italy, 11AESARA Europe GmbH, Zug, ZG, Switzerland, 12Merck Healthcare KGaA, Darmstadt, HE, Germany, 13Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, EM, Mexico, 14Department of Internal Medicine – Endocrinology, Bali Royal Hospital, Denpasar, President of Indonesian Thyroid Association InaTA, Denpasar, Indonesia, Indonesia

Presentation Documents

OBJECTIVES: Hypothyroidism is a common health concern in Indonesia and Mexico, especially in emerging markets. If left untreated during pregnancy, hypothyroidism can cause significant health problems for both the mother and child, leading to increased healthcare costs. Therefore, implementing cost-effective screening and intervention strategies is crucial to reduce the expenses associated with untreated hypothyroidism and enhance maternal and fetal health outcomes. To assess the cost-effectiveness of universal hypothyroidism screening versus high-risk screening and no screening and to inform healthcare policies and decision-making processes regarding the most efficient approach to hypothyroidism screening during pregnancy in Indonesia and Mexico.

METHODS: The model structure was slightly different for the two countries to adapt to the availability of local prevalence data. Data from previously published cost-effectiveness analysis and RWE was also collected to analyze costs and outcomes (miscarriages, preterm births, stunting and QALYs) within a pregnancy horizon healthcare system considering a healthcare system perspective. Full public funding was assumed as base case, but various combinations of alternative reimbursement approaches were also assessed. Local clinical experts validated the model assumptions and one way sensitivity analysis (OWSA) identified key drivers of the results. Based on each country characteristics we run specific scenario analyses.

RESULTS: In both analyses, in the base case analysis, universal screening for hypothyroidism dominates both no screening and high-risk screening as it results in lower costs, fewer expected events (i.e. miscarriages and preterm deliveries), and higher quality-adjusted life years (QALYs). The results are most sensitive to changes in utility values and screening inputs.

CONCLUSIONS: In emerging markets such as Indonesia and Mexico, universal screening dominates high-risk and no screening under public sector funding. Policymakers are encouraged to integrate universal screening protocols into maternal healthcare to achieve improved health outcomes and cost savings.

Code

EE602

Topic

Economic Evaluation, Health Policy & Regulatory

Topic Subcategory

Budget Impact Analysis, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Public Spending & National Health Expenditures

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity), Reproductive & Sexual Health