Cost-effectiveness analysis of thyroid disease screening in pregnant women in China_West China Medical Journal

Authors：

WANG Ting ¹ , ZENG Qingyuan ¹ , GUO Jianming ² , XIAO Jingjing ³ ,  DONG Siping ^4,5

1. Department of Pharmacy, Wuhan Third Hospital / Tongren Hospital of Wuhan University, Wuhan, Hubei 430061, P. R. China;
2. Department of Pharmacy, Sanming Second Hospital, Sanming, Fujian 353000, P. R. China;
3. Journal of Chinese Hospital Architecture and Equipment, Beijing 100044, P. R. China;
4. National Institute of Hospital Administration, National Health Commission, Beijing 100083, P. R. China;
5. School of Politics and Public Administration, Wuhan University, Wuhan, Hubei 430072, P. R. China;

Corresponding?author：

DONG Siping, Email: sipingd@163.com

Keywords：

Pregnant women; thyroid disease screening; cost-effectiveness analysis; decision tree modeling; Markov modeling

DOI：

10.7507/1002-0179.202412176

Video：

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Objective To compare the economic effectiveness of universal screening, high-risk population screening, and no screening strategies for thyroid disease prevention and control among pregnant women in China through cost-effectiveness analysis, providing evidence-based support for optimizing health policy decisions on prenatal thyroid disease screening. Methods Based on the characteristics of thyroid disorders during pregnancy, a combined decision tree and Markov model was developed to conduct a lifetime cost-effectiveness analysis across three strategies: no screening, high-risk population screening, and universal screening. Sensitivity analyses were performed on key parameters. Results Base-case analysis demonstrated that universal screening was the most cost-effective strategy when the World Health Organization (WHO)-recommended payment threshold of 1×gross domestic product (GDP) per capita was used, with an incremental cost-effectiveness ratio (ICER) of 20636.18 yuan per quality-adjusted life year (QALY) compared to no screening, followed by high-risk population screening (ICER=21071.71 yuan/QALY). The results of the sensitivity analysis showed a strong stability of the model. Conclusions Of the 3 screening programs for thyroid disease in pregnancy, universal screening is the most cost-effective when the WHO-recommended payment threshold of 1×GDP per capita is used.

Citation： WANG Ting, ZENG Qingyuan, GUO Jianming, XIAO Jingjing, DONG Siping. Cost-effectiveness analysis of thyroid disease screening in pregnant women in China. West China Medical Journal, 2025, 40(4): 554-560. doi: 10.7507/1002-0179.202412176 Copy

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2.	Gao X, Li Y, Li J, et al. Gestational TSH and FT₄ reference intervals in Chinese women: a systematic review and meta-analysis. Front Endocrinol (Lausanne), 2018, 9: 432.
3.	Shan ZY, Chen YY, Teng WP, et al. A study for maternal thyroid hormone deficiency during the first half of pregnancy in China. Eur J Clin Invest, 2009, 39(1): 37-42.
4.	Zhang Y, Sun W, Zhu S, et al. The impact of thyroid function and TPOAb in the first trimester on pregnancy outcomes: a retrospective study in peking. J Clin Endocrinol Metab, 2020, 105(3): dgz167.
5.	Su PY, Huang K, Hao JH, et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab, 2011, 96(10): 3234-3241.
6.	Thangaratinam S, Tan A, Knox E, et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ, 2011, 342: d2616.
7.	Li Y, Shan Z, Teng W, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol (Oxf), 2010, 72(6): 825-829.
8.	Ghassabian A, Bongers-Schokking JJ, de Rijke YB, et al. Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in children: the Generation R Study. Thyroid, 2012, 22(2): 178-186.
9.	Dosiou C, Barnes J, Schwartz A, et al. Cost-effectiveness of universal and risk-based screening for autoimmune thyroid disease in pregnant women. J Clin Endocrinol Metab, 2012, 97(5): 1536-1546.
10.	Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. Am J Obstet Gynecol, 2009, 200(3): 267.e1-267.e7.
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16.	Yang H, Shao M, Chen L, et al. Screening strategies for thyroid disorders in the first and second trimester of pregnancy in China. PLoS One, 2014, 9(6): e99611.
17.	張曉璐. 妊娠期甲狀腺疾病的臨床流行病學調查. 北京: 首都醫科大學, 2013.
18.	Negro R, Formoso G, Mangieri T, et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab, 2006, 91(7): 2587-2591.
19.	Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab, 2010, 95(4): 1699-1707.
20.	劉家昌. 甲狀腺功能減退癥誤診原因分析. 臨床誤診誤治, 1999, 12(5): 327-328.
21.	Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf), 1995, 43(1): 55-68.
22.	國家統計局. 中國人口普查年鑒-2020. 北京: 中國統計出版社, 2020.
23.	蔡海瑞, 舒立波, 李冬梅, 等. 女性妊娠期甲狀腺功能減退與產后焦慮、抑郁情緒的關系. 中國現代醫生, 2018, 56(12): 55-58.

1. Teng W, Shan Z, Patil-Sisodia K, et al. Hypothyroidism in pregnancy. Lancet Diabetes Endocrinol, 2013, 1(3): 228-237.
2. Gao X, Li Y, Li J, et al. Gestational TSH and FT₄ reference intervals in Chinese women: a systematic review and meta-analysis. Front Endocrinol (Lausanne), 2018, 9: 432.
3. Shan ZY, Chen YY, Teng WP, et al. A study for maternal thyroid hormone deficiency during the first half of pregnancy in China. Eur J Clin Invest, 2009, 39(1): 37-42.
4. Zhang Y, Sun W, Zhu S, et al. The impact of thyroid function and TPOAb in the first trimester on pregnancy outcomes: a retrospective study in peking. J Clin Endocrinol Metab, 2020, 105(3): dgz167.
5. Su PY, Huang K, Hao JH, et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab, 2011, 96(10): 3234-3241.
6. Thangaratinam S, Tan A, Knox E, et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ, 2011, 342: d2616.
7. Li Y, Shan Z, Teng W, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol (Oxf), 2010, 72(6): 825-829.
8. Ghassabian A, Bongers-Schokking JJ, de Rijke YB, et al. Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in children: the Generation R Study. Thyroid, 2012, 22(2): 178-186.
9. Dosiou C, Barnes J, Schwartz A, et al. Cost-effectiveness of universal and risk-based screening for autoimmune thyroid disease in pregnant women. J Clin Endocrinol Metab, 2012, 97(5): 1536-1546.
10. Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. Am J Obstet Gynecol, 2009, 200(3): 267.e1-267.e7.
11. 劉鵬, 蘇曉輝, 申紅梅, 等. 2011 年全國碘缺乏病病情監測結果分析. 中華地方病學雜志, 2015, 34(3): 181-185.
12. Rao M, Zeng Z, Zhou F, et al. Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity: a systematic review and meta-analysis. Hum Reprod Update, 2019, 25(3): 344-361.
13. 國家統計局. 中國統計年鑒 2023. 北京: 中國統計出版社, 2023.
14. 劉國恩, 胡善聯, 吳久鴻. 中國藥物經濟學評價指南(2020 版). 北京: 中國市場出版社, 2020: 30.
15. 中華醫學會內分泌學分會, 中華醫學會圍產醫學分會. 妊娠和產后甲狀腺疾病診治指南(第 2 版). 中華內分泌代謝雜志, 2019, 35(8): 636-665.
16. Yang H, Shao M, Chen L, et al. Screening strategies for thyroid disorders in the first and second trimester of pregnancy in China. PLoS One, 2014, 9(6): e99611.
17. 張曉璐. 妊娠期甲狀腺疾病的臨床流行病學調查. 北京: 首都醫科大學, 2013.
18. Negro R, Formoso G, Mangieri T, et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab, 2006, 91(7): 2587-2591.
19. Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab, 2010, 95(4): 1699-1707.
20. 劉家昌. 甲狀腺功能減退癥誤診原因分析. 臨床誤診誤治, 1999, 12(5): 327-328.
21. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf), 1995, 43(1): 55-68.
22. 國家統計局. 中國人口普查年鑒-2020. 北京: 中國統計出版社, 2020.
23. 蔡海瑞, 舒立波, 李冬梅, 等. 女性妊娠期甲狀腺功能減退與產后焦慮、抑郁情緒的關系. 中國現代醫生, 2018, 56(12): 55-58.

West China Medical Journal

Cost-effectiveness analysis of thyroid disease screening in pregnant women in China

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