COST-EFFECTIVENESS OF UNIVERSAL SCREENING FOR HYPOTHYROIDISM IN MALAYSIAN PREGNANT WOMEN
Author(s)
Jing Sheng Lim, MPhil, PhD1, Muniswaran Ganeshan, MObGyn (Mal), FRCOG (UK), MFM (Mal/UK)2, Ping Foo Wong, Dr Fam Med (UKM), MAFP, FRACGP3, Julian Dettenbach, MBA4, Stephanie Koh, RPh5, Caryn Chuen Wei Lee, RPh5, Kenneth KC Lee, BSc, MS, RPh, PhD1.
1Monash University Malaysia, Subang Jaya, Malaysia, 2Pantai Hospital Kuala Lumpur; Visiting Lecturer, University of Malaya, Kuala Lumpur, Malaysia, 3Cheras Health Clinic, Kuala Lumpur, Malaysia, 4the healthcare business of Merck KGaA, Darmstadt, Germany, Darmstadt, Germany, 5Merck Sdn Bhd, Petaling Jaya, Malaysia, an affiliate of Merck KGaA, Darmstadt, Germany, Petaling Jaya, Malaysia.
1Monash University Malaysia, Subang Jaya, Malaysia, 2Pantai Hospital Kuala Lumpur; Visiting Lecturer, University of Malaya, Kuala Lumpur, Malaysia, 3Cheras Health Clinic, Kuala Lumpur, Malaysia, 4the healthcare business of Merck KGaA, Darmstadt, Germany, Darmstadt, Germany, 5Merck Sdn Bhd, Petaling Jaya, Malaysia, an affiliate of Merck KGaA, Darmstadt, Germany, Petaling Jaya, Malaysia.
OBJECTIVES: To assess the cost-effectiveness of universal screening (US) for hypothyroidism versus high-risk (HR) and no screening (NS) among pregnant women in Malaysia.
METHODS: A decision-tree model assessed costs and outcomes (miscarriages, preterm births and QALYs) from the Malaysian healthcare system perspective. The analysis adopted a within-pregnancy time horizon; therefore, long-term impact such as the neurodevelopmental outcomes in infants were excluded. TSH and T4 levels were assumed to be tested in 1st and 2nd trimesters, treatment initiation for TSH >2.5 mIU/L and low T4. If TSH >2.5 mIU/L and T4 were normal, only high-risk women were treated. Unscreened women could undergo symptom-related testing. Trimester specific TSH and T4 distributions were extracted from relevant regional studies.1-7 Local clinical experts validated the model assumptions and one way sensitivity analysis identified key drivers of the results.
RESULTS: US for gestational hypothyroidism is cost-effective versus both HR screening and NS across the public and private healthcare sectors, as the higher overall costs were partially offset by less expected events (miscarriages and preterm deliveries) and higher QALYs. The incremental cost-effectiveness ratio (ICER) of US vs HR screening was RM 15,620/QALY in the public sector and RM 20,390/QALY in the private sector. The ICERs of US vs NS in the public and private sectors were respectively, RM 13,455/QALY and RM 15,987/QALY. All ICERs fell below the implied Malaysian cost-effectiveness willingness-to-pay threshold of RM 55,800/QALY (2024 Malaysian GDP per capita8). Results are most sensitive to utility values, prevalence of hypothyroidism in the second trimester and screening costs.
CONCLUSIONS: US is cost-effective compared to NS and HR screening, as higher overall costs are associated with less expected events and higher QALYs. These findings provide a valuable starting point for further research to understand the long-term impact of US for hypothyroidism in pregnancy, and to help inform the development of national screening policy.
METHODS: A decision-tree model assessed costs and outcomes (miscarriages, preterm births and QALYs) from the Malaysian healthcare system perspective. The analysis adopted a within-pregnancy time horizon; therefore, long-term impact such as the neurodevelopmental outcomes in infants were excluded. TSH and T4 levels were assumed to be tested in 1st and 2nd trimesters, treatment initiation for TSH >2.5 mIU/L and low T4. If TSH >2.5 mIU/L and T4 were normal, only high-risk women were treated. Unscreened women could undergo symptom-related testing. Trimester specific TSH and T4 distributions were extracted from relevant regional studies.1-7 Local clinical experts validated the model assumptions and one way sensitivity analysis identified key drivers of the results.
RESULTS: US for gestational hypothyroidism is cost-effective versus both HR screening and NS across the public and private healthcare sectors, as the higher overall costs were partially offset by less expected events (miscarriages and preterm deliveries) and higher QALYs. The incremental cost-effectiveness ratio (ICER) of US vs HR screening was RM 15,620/QALY in the public sector and RM 20,390/QALY in the private sector. The ICERs of US vs NS in the public and private sectors were respectively, RM 13,455/QALY and RM 15,987/QALY. All ICERs fell below the implied Malaysian cost-effectiveness willingness-to-pay threshold of RM 55,800/QALY (2024 Malaysian GDP per capita8). Results are most sensitive to utility values, prevalence of hypothyroidism in the second trimester and screening costs.
CONCLUSIONS: US is cost-effective compared to NS and HR screening, as higher overall costs are associated with less expected events and higher QALYs. These findings provide a valuable starting point for further research to understand the long-term impact of US for hypothyroidism in pregnancy, and to help inform the development of national screening policy.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE45
Topic
Economic Evaluation
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)