RESUMEN
BACKGROUND: Primary hypothyroidism affects about 3% of the general population in Europe. In most cases people with hypothyroidism are treated with levothyroxine. In the context of the 2023 British Thyroid Association guidance and the 2020 Competitions and Marketing Authority (CMA) ruling, we examined prescribing data for levothyroxine, Natural desiccated thyroid (NDT) and liothyronine by dose, regarding changes over the years 2016-2022. DESIGN: Monthly primary care prescribing data for each British National Formulary code were analysed for levothyroxine, liothyronine and NDT. PATIENTS AND MEASUREMENTS: The rolling 12-month total/average of cost or prescribing volume was used to identify the moment of change. Results included number of prescriptions, the actual costs, and the cost/prescription/mcg of drug. RESULTS: Liothyronine: In 2016 94% of the total 74,500 prescriptions were of the 20 mcg dose. In 2020 the percentage prescribed in the 5 mcg and 10 mcg doses started to increase so that by 2022 each reached nearly 27% of total liothyronine prescribing. The average cost/prescription in 2016 of 20 mcg was £404/prescription and this fell by 80% to £101 in 2022; while the 10 mcg cost of £348/prescription fell by only 35% to £255 and the 5 mcg cost of £355/prescription fell by 38% to £242/prescription. The total prescriptions of liothyronine in 2016 were 74,605, falling by 30% up to 2019 when they started to grow again - most recently at 60,990-15% lower than the 2016 figure, with the result that total costs fell by 70% to £9 m/year. CONCLUSIONS: Liothyronine costs fell after the CMA ruling but remain orders of magnitude higher than for levothyroxine. The remaining 0.2% of patients with liothyronine treated hypothyroidism are still absorbing 16% of medication costs. The lower liothyronine 5cmg and 10 mcg doses as recommended by BTA are 240% the costs of the 20 mcg dose. Thus, following latest BTA guidance which recommends the lower liothyronine doses still incurs substantial additional costs vs the prescribing liothyronine in the no longer recommended treatment regime. High drug price continues to impact clinical decisions, potentially limiting liothyronine therapy availability to a considerable number of patients who could benefit from this treatment.
Asunto(s)
Hipotiroidismo , Humanos , Inglaterra , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/economía , Triyodotironina/uso terapéutico , Triyodotironina/economía , Tiroxina/uso terapéutico , Tiroxina/economía , Tiroxina/administración & dosificación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Prescripciones de Medicamentos/economía , Prescripciones de Medicamentos/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Costos de los MedicamentosRESUMEN
BACKGROUND: Thyroid dysfunction accounts for majority of endocrine disorders. In sub-Saharan Africa Graves' disease and hypothyroidism have accounted for 13.1% and 8.8% while the burden of thyroid disorder has ranged from 6.18 to47.34% among countries in the Arab world. The cost for a primary thyroid test done to evaluate the gland function constituted a large proportion of the public health budget. For instance, 10 million thyroid functions have been done each year by laboratories which cost 30 million UK pounds, and they represent 8% of laboratory charge in the US. When a TSH-only protocol (guideline) was used, 95% of the requests were sufficient for diagnosis without requiring further tests, thereby resulting in 50% savings on FT4 reagent and reducing the annual TFT reagent cost by 25%. This is an original study, and its objective was to assess the ordering pattern of TSH tests and their cost-effectiveness in patients' samples referred to ICL from Addis Ababa health facilities between July2015 to June 2016. METHOD: An institution-based cross-sectional study design was utilized to study the ordering pattern of thyroid function tests using one-year retrospective data from ICL. RESULTS: Thyroid profiles were ordered more frequently (49.5%) compared to TSH only (24.3%). An additional 2625.70 USD was paid by patients for individual components in the profile tests that turned out normal. CONCLUSION: Guidelines advocate TSH as the initial test for thyroid dysfunction, but the use of a combination of tests is more common.
Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Instituciones de Salud/economía , Laboratorios/economía , Derivación y Consulta/economía , Pruebas de Función de la Tiroides/economía , Análisis Costo-Beneficio , Estudios Transversales , Etiopía , Enfermedad de Graves/diagnóstico , Enfermedad de Graves/economía , Humanos , Hipotiroidismo/diagnóstico , Hipotiroidismo/economía , Pautas de la Práctica en Medicina/economía , Estudios RetrospectivosRESUMEN
Introducción: La hipertirotropinemia aislada se describe como un a elevación de la hormona estimulante del tiroides (TSH) con niveles normales de hormonas tiroideas y autoinmunidad negativa en pacientes asintomáticos y sin hallazgos en la exploración. Dado el aumento no justificado del análisis de la función tiroidea en niños asintomáticos, el objetivo principal es analizar la evolución de estos pacientes. Como objetivo secundario se realiza un análisis de costes asociado. Material y métodos: Estudio longitudinal observacional retrospectivo de los pacientes derivados a endocrinología de un hospital de tercer nivel por hipertirotropinemia aislada (TSH 5-20 mUI/l). Se recogieron variables clínicas, analíticas, número de visitas hasta el alta, necesidad de tratamiento, tiempo de seguimiento, así como variables económicas. Resultados: Se obtuvo una muestra de 155 pacientes, con edad media de 7,8 años ± 3,6 DE. La derivación a endocrinología representó el 4% de las consultas de primera visita. La cifra media de TSH inicial fue de 7,8 mU/l (5,03-15,8 mU/l). Los niveles de TSH se normalizaron tras la primera repetición durante el mes posterior, en el 60% de los casos. En un intervalo máximo de 3años fueron dados de alta el 83,6%, con un seguimiento medio de 8,14 ± 6,8 meses y 2,4 visitas/paciente. Se obtuvo un coste medio de 251,27 €/paciente (rango 143,49-444,21 €). Conclusión: Es fundamental no generar alarma familiar ante una hipertirotropinemia, dado que se trata de una situación bioquímica que, en la mayoría de los casos, se normaliza. Este hecho, junto con el coste medio derivado de la asistencia especializada, pone de manifiesto que el primer paso debería ser la repetición de la misma en atención primaria
Introduction: Subclinical hypothyroidism is defined as elevation of thyroid-stimulating hormone (TSH) levels, with normal thyroid hormone levels and negative autoimmunity, in asymptomatic patients with no findings on examination. Because of the unwarranted increase in thyroid function tests in asymptomatic children, the main objective of this review was to analyze the course of these patients. Analysis of associated costs was a secondary objective. Material and methods: A longitudinal, observational, retrospective study of patients referred to the endocrinology department of a tertiary hospital for high TSH levels (TSH 5-20 mIU/L). Clinical and laboratory variables, number of visits until discharge, need for treatment, monitoring time, and economic variables were collected. Results: The study sample consisted of 155 patients with a mean age of 7.8 years ± 3.6SD. Referrals to endocrinology accounted for 4% of first office visits. Baseline mean TSH level was 7.8 mU/L (5.03-15.8 mU/L). TSH levels normalized after the first repeated measurement during the subsequent month in 60% of cases. A total of 83.6% of patients were discharged within a maximum of 3years, with a mean follow-up of 8.14 ± 6.8 months and 2.4 visits/patient. Average cost per patient was € 251.27 (range € 143.49-444.21). Conclusion: It is essential not to alarm the family when subclinical hypothyroidism is detected, because this is a biochemical situation which normalizes in most cases. This fact, together with the mean cost of specialized care, suggests that the first step should be repeated TSH measurements in primary care
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Evolución Clínica , Hipotiroidismo/economía , Atención Primaria de Salud/economía , Tirotropina/sangre , Estudios Longitudinales , Estudios Retrospectivos , Autoinmunidad , Costos y Análisis de CostoRESUMEN
INTRODUCTION: Subclinical hypothyroidism is defined as elevation of thyroid-stimulating hormone (TSH) levels, with normal thyroid hormone levels and negative autoimmunity, in asymptomatic patients with no findings on examination. Because of the unwarranted increase in thyroid function tests in asymptomatic children, the main objective of this review was to analyze the course of these patients. Analysis of associated costs was a secondary objective. MATERIAL AND METHODS: A longitudinal, observational, retrospective study of patients referred to the endocrinology department of a tertiary hospital for high TSH levels (TSH 5-20mIU/L). Clinical and laboratory variables, number of visits until discharge, need for treatment, monitoring time, and economic variables were collected. RESULTS: The study sample consisted of 155 patients with a mean age of 7.8years ±3.6SD. Referrals to endocrinology accounted for 4% of first office visits. Baseline mean TSH level was 7.8mU/L (5.03-15.8mU/L). TSH levels normalized after the first repeated measurement during the subsequent month in 60% of cases. A total of 83.6% of patients were discharged within a maximum of 3years, with a mean follow-up of 8.14 ±6.8months and 2.4visits/patient. Average cost per patient was 251.27 (range 143.49-444.21). CONCLUSION: It is essential not to alarm the family when subclinical hypothyroidism is detected, because this is a biochemical situation which normalizes in most cases. This fact, together with the mean cost of specialized care, suggests that the first step should be repeated TSH measurements in primary care.
Asunto(s)
Hipotiroidismo/sangre , Tirotropina/sangre , Enfermedades Asintomáticas , Niño , Costos y Análisis de Costo , Femenino , Humanos , Hipotiroidismo/economía , Masculino , Remisión Espontánea , Estudios Retrospectivos , Pruebas de Función de la Tiroides , Hormonas Tiroideas/sangre , Factores de TiempoAsunto(s)
Costos de los Medicamentos/tendencias , Prescripciones de Medicamentos/economía , Triyodotironina/economía , Inglaterra/epidemiología , Humanos , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/economía , Hipotiroidismo/epidemiología , Receptores de Hormona Tiroidea , Triyodotironina/uso terapéuticoRESUMEN
BACKGROUND: Thyroid function tests (TFTs) are among the most requested tests internationally. However, testing practice is inconsistent, and potentially suboptimal and overly costly. The natural history of thyroid function remains poorly understood. AIM: To establish the stability of thyroid function over time, and identify predictors of development of overt thyroid dysfunction. DESIGN AND SETTING: Longitudinal follow-up in 19 general practices in the UK. METHOD: A total of 2936 participants from the Birmingham Elderly Thyroid Study (BETS 1) with a baseline TFT result indicating euthyroid or subclinical state were re-tested after approximately 5 years. Change in thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid status between baseline and follow-up was determined. Predictors of progression to overt dysfunction were modelled. RESULTS: Participants contributed 12 919 person-years; 17 cases of overt thyroid dysfunction were identified, 13 having been classified at baseline as euthyroid and four as having subclinical thyroid dysfunction. Individuals with subclinical results at baseline were 10- and 16-fold more likely to develop overt hypothyroidism and hyperthyroidism, respectively, compared with euthyroid individuals. TSH and FT4 demonstrated significant stability over time, with 61% of participants having a repeat TSH concentration within 0.5 mIU/L of their original result. Predictors of overt hypothyroidism included new treatment with amiodarone (odds ratio [OR] 92.1), a new diagnosis of atrial fibrillation (OR 7.4), or renal disease (OR 4.8). CONCLUSION: High stability of thyroid function demonstrated over the 5-year interval period should discourage repeat testing, especially when a euthyroid result is in the recent clinical record. Reduced repeat TFTs in older individuals is possible without conferring risk, and could result in significant cost savings.
Asunto(s)
Hipotiroidismo/diagnóstico , Pruebas de Función de la Tiroides/estadística & datos numéricos , Glándula Tiroides/fisiopatología , Anciano , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Humanos , Hipotiroidismo/economía , Hipotiroidismo/fisiopatología , Estudios Longitudinales , Masculino , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Pruebas de Función de la Tiroides/economía , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. METHODOLOGY: A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. RESULTS: Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were 5,786 for universal screening, 5,791 for high risk screening, and 5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in 2,653,854 annual savings for the Spanish National Health System. CONCLUSIONS: Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of 374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.
Asunto(s)
Costos de la Atención en Salud , Hipotiroidismo/diagnóstico , Tamizaje Masivo/economía , Pruebas de Detección del Suero Materno/economía , Programas Nacionales de Salud/economía , Complicaciones del Embarazo/diagnóstico , Pruebas de Función de la Tiroides/economía , Aborto Espontáneo/epidemiología , Adulto , Simulación por Computador , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Femenino , Gastos en Salud/estadística & datos numéricos , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/economía , Hipotiroidismo/epidemiología , Trabajo de Parto Prematuro/epidemiología , Embarazo , Complicaciones del Embarazo/economía , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Primer Trimestre del Embarazo , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , España/epidemiología , Pruebas de Función de la Tiroides/estadística & datos numéricosRESUMEN
Because of expanding indications and improvements in supportive care, the utilization of blood and marrow cell transplantation (BMT) to treat various conditions is increasing exponentially, and currently more than 60,000 BMTs are performed annually worldwide. By the year 2030, it is projected that the number of BMT survivors will increase 5-fold, potentially resulting in one half of a million survivors in the United States alone. As the majority of survivors now live beyond the first 2 years after BMT, they are prone to a unique set of complications and late effects. Until recently, BMT experts assumed responsibility for almost all of the care for these survivors, but now oncologists/hematologists, pediatricians, and internists are involved frequently in offering specialized care and preventive services to these survivors. To integrate and translate into clinical practice the unique BMT survivorship issues with current preventive guidelines, a team effort is required. This can be facilitated by a dedicated "long-term-follow-up (LTFU)" clinic that provides lifelong care for BMT survivors. In this review, we first illustrate with clinical vignettes the need for LTFU and then focus upon the following: (1) types of LTFU clinic models, (2) challenges and possible solutions to the establishment of LTFU clinic, and (3) vulnerable transition periods.
Asunto(s)
Necesidades y Demandas de Servicios de Salud/organización & administración , Neoplasias Hematológicas/terapia , Hospitales Especializados/economía , Sobrevivientes , Adulto , Anciano , Trasplante de Médula Ósea/efectos adversos , Catarata/economía , Catarata/etiología , Catarata/psicología , Catarata/terapia , Niño , Enfermedad Crónica , Enfermedad Injerto contra Huésped/economía , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/psicología , Enfermedad Injerto contra Huésped/terapia , Neoplasias Hematológicas/patología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Hipotiroidismo/economía , Hipotiroidismo/etiología , Hipotiroidismo/psicología , Hipotiroidismo/terapia , Síndrome Metabólico/economía , Síndrome Metabólico/etiología , Síndrome Metabólico/psicología , Síndrome Metabólico/terapia , Modelos Económicos , Trastornos por Estrés Postraumático/economía , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Estados Unidos , Recursos HumanosRESUMEN
BACKGROUND: Hypothyroidism is associated with an increased somatic and psychiatric disease burden. Whether there are any socioeconomic consequences of hypothyroidism, such as early retirement or loss of income, remains unclarified. AIM: Our aim was to examine, compared with a matched control group, the risk of receiving disability pension (before the age of 60) and the effect on labor market income in patients diagnosed with hypothyroidism. METHODS: This was an observational register-based cohort study. By record linkage between different Danish health registers, 1745 hypothyroid singletons diagnosed before the age of 60 were each matched with 4 non-hypothyroid controls and followed for a mean of 5 (range 1-31) years. Additionally, we included 277 same-sex twin pairs discordant for hypothyroidism. The risk of disability pension was evaluated by the Cox regression analysis. Changes in labor market income progression over 5 years were evaluated using a difference in difference model. RESULTS: With a hazard ratio of 2.24 (95% confidence interval = 1.73-2.89), individuals diagnosed with hypothyroidism had a significantly increased risk of disability pension. This remained significant when adjusting for educational level and comorbidity (hazard ratio = 1.89; 95% confidence interval = 1.42-2.51). In an analysis of labor market income, 2 years before compared with 2 years after the diagnosis of hypothyroidism, the hypothyroid individuals had on average a 1605 poorer increase than their euthyroid controls (P < .001). Essentially similar results were found in the twin population. CONCLUSION: A diagnosis of hypothyroidism before the age of 60 is associated with loss of labor market income and an 89% increased risk of receiving a disability pension.
Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Hipotiroidismo/economía , Hipotiroidismo/epidemiología , Renta/estadística & datos numéricos , Pensiones/estadística & datos numéricos , Comorbilidad , Dinamarca/epidemiología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sistema de Registros/estadística & datos numéricos , Jubilación/economía , Jubilación/estadística & datos numéricosRESUMEN
The prevalence of constipation in children is high and accounts for a large percentage of pediatric and pediatric gastroenterology visits. Thyroid testing is frequently ordered to evaluate constipation and other gastrointestinal complaints in children. We reviewed all of the patients with thyroid testing ordered by our pediatric gastroenterology division during a 5-year period. We found 873 patients on whom thyroid testing was performed, and 56 patients had evidence of hypothyroidism. Nine patients had constipation and clinically significant hypothyroidism in this group; however, only 1 child had constipation as their sole presenting symptom. The contribution of occult hypothyroidism to isolated constipation in children may have been previously overestimated.
Asunto(s)
Estreñimiento/etiología , Hipotiroidismo/diagnóstico , Pruebas de Función de la Tiroides , Adolescente , Niño , Insuficiencia de Crecimiento/etiología , Femenino , Trastornos del Crecimiento/etiología , Costos de la Atención en Salud , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/economía , Masculino , Prevalencia , Estudios Retrospectivos , Pruebas de Función de la Tiroides/economía , Adulto JovenRESUMEN
BACKGROUND: Previous research has suggested that increases in length of stay and hospital cost in patients undergoing spine surgery can be due to comorbidities, especially diabetes mellitus. To study how endocrine comorbidities impact spine surgery cost, we conducted the further analysis. METHODS: We reviewed the charts of 787 patients operated between 2005 and 2008 and their treatment cost. Patients underwent one of three of the most common types of spine surgery: lumbar microdiskectomy (N = 237), anterior cervical decompression and fusion (N = 339), and lumbar decompression and fusion (N = 211). Patients were 14 to 92 years of age (mean 54.5 years), nearly equally divided by gender and mostly white. Demographics, body mass index, and comorbidities were studied versus length of stay and hospital charges. Data were analyzed using the Mann-Whitney and Pearson χ(2) tests with the help of the SPSS v16 software. RESULTS: Among the 653 patients who had their glycosylated hemoglobin (HbA1c) level measured, 32.5% had an HbA1c level ≥6.1% and 4.3% had high HbA1c level and hypothyroidism. These two comorbidities increased with age. Cost analysis showed that in the lumbar decompression and fusion group, length of stay and hospital cost significantly increased with these comorbidities. Without HbA1c elevation or hypothyroidism, the average length of stay for lumbar decompression and fusion patients was 5 days. This increased to 6 days with hypothyroidism. With both comorbidities the average length of stay increased to 8 days (P < .01). Regarding hospital cost, without these comorbidities the average was approximately $52,449. With elevated HbA1c the cost increased to $56,176 and with hypothyroidism to $63,278 (P < .01 and P < .05, respectively). When both comorbidities were present the average hospital cost was $71,352. It was also noted that 89.7% of the patients with hypothyroidism were women. Cost and length of stay increased with age in the female lumbar decompression and fusion group. In addition, there was a surge in length of stay and cost in the ≥70-year-old female group with hypothyroidism undergoing anterior cervical decompression and fusion. CONCLUSIONS: HbA1c elevation and hypothyroidism have an additive effect on hospital cost in lumbar decompression and fusion female patients. The finding of a surge in hospital cost parameters in elderly female hypothyroid patients undergoing surgery on their cervical spine needs more investigation.
Asunto(s)
Enfermedades del Sistema Endocrino/complicaciones , Enfermedades del Sistema Endocrino/economía , Enfermedades de la Columna Vertebral/economía , Enfermedades de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Descompresión Quirúrgica/economía , Complicaciones de la Diabetes/economía , Discectomía/economía , Enfermedades del Sistema Endocrino/epidemiología , Femenino , Hemoglobina Glucada/metabolismo , Costos de Hospital , Hospitalización/economía , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/economía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Enfermedades de la Columna Vertebral/complicaciones , Fusión Vertebral/economía , Adulto JovenRESUMEN
OBJECTIVE: To assess clinical utility of time-of-day-based thyrotropin (TSH) ranges. STUDY DESIGN: Ranges for TSH at 8 am, 4 pm, and am/pm TSH ratio were developed from prior data in 94 typical children (age, 5 to 18 years). Data for these values in 227 short children (1.5 to 18 years) were compared with those in typical children. RESULTS: Short children included idiopathic short stature (ISS, n=153), central hypothyroidism (Central, n=42), and mild primary hypothyroidism (Primary, n=32), referred for evaluation of growth. In typical children, ISS, and Primary, 8 am TSH was greater than 4 pm TSH (P<.05). In Primary, 8 am TSH was greater than normal. Only 4 with Primary had elevated 4 pm TSH (using usual laboratory range of 0.5 to 4 mU/L). In contrast, only 63% of 4 pm TSHs in Primary were elevated. compared with 95% confidence limits in typical children. In Central, 8 am TSH and 4 pm TSH were within normal time-of-day range, and FT4 was in lowest one-third of normal. am/pm TSH ratio was less than 95% confidence limits in 76% of those with Central. CONCLUSIONS: Either 8 am TSH or 4 pm TSH (compared with time-of-day normal range) can identify TSH elevation. Low am/pm TSH ratio (FT4 in lowest one-third of normal) confirms central hypothyroidism. Thus, time-of-day TSH ranges should be used for accurate diagnosis and more appropriate cost-effective treatment of mild hypothyroidism.
Asunto(s)
Hipotiroidismo/sangre , Tirotropina/sangre , Adolescente , Estatura , Niño , Preescolar , Análisis Costo-Beneficio , Femenino , Hormona del Crecimiento/deficiencia , Humanos , Hipotiroidismo/economía , Hipotiroidismo/terapia , Masculino , Valores de Referencia , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Co-morbidities in men and women with sleep-disordered breathing (SDB) were compared retrospectively to an age-standardized, general Finnish population. The prevalence of diseases was based on the reimbursement refunds of medications. METHODS: Two hundred thirty-three age- and BMI-matched male-female pairs and 368 consecutive women identified from our sleep recording database were included. Data on medication were gathered from the National Agency for Medicines and Social Insurance Institution database. RESULTS: Men with SDB had three-fold prevalence of reimbursed medication for diabetes and two-fold prevalence of reimbursed medication for chronic arrhythmia. Women with SDB had three-fold prevalence of reimbursed medication for thyroid insufficiency, and postmenopausal women had two-fold prevalence of reimbursed medication for psychosis. BMI and age did not explain prevalence of reimbursed medications for chronic arrhythmia or psychosis. In both genders with SDB, prevalence of reimbursed medications compared to the general population was two-fold for hypertension and seven-fold for asthma and/or chronic obstructive pulmonary disease (COPD). Partial upper airway obstruction was associated with three-fold prevalence of reimbursed medication for asthma and/or COPD in both genders and 60% reduced prevalence of reimbursed medication for hypertension in females matched for age and BMI. CONCLUSIONS: Co-morbidity profile differed between genders. Our results emphasize the importance of diagnosis and treatment of co-morbidities and partial upper airway obstruction.
Asunto(s)
Arritmias Cardíacas/tratamiento farmacológico , Arritmias Cardíacas/epidemiología , Asma/tratamiento farmacológico , Asma/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Costos de los Medicamentos/estadística & datos numéricos , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/epidemiología , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/estadística & datos numéricos , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Apnea Obstructiva del Sueño/tratamiento farmacológico , Apnea Obstructiva del Sueño/epidemiología , Factores de Edad , Arritmias Cardíacas/economía , Asma/economía , Índice de Masa Corporal , Enfermedad Crónica , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/economía , Femenino , Finlandia , Encuestas Epidemiológicas , Humanos , Hipotiroidismo/economía , Masculino , Trastornos Psicóticos/economía , Enfermedad Pulmonar Obstructiva Crónica/economía , Estudios Retrospectivos , Factores Sexuales , Apnea Obstructiva del Sueño/economíaRESUMEN
Fundamentos: Estudos demonstram que a mensuração dos níveis de colesterol não HDL (não HDL-C) apresenta melhor associação com doença coronariana que o LDL-C. Pouco se tem publicado sobre os níveis de não HDL-C em pacientes com hipotireoidismo subclínico (HS). Objetivos: Avaliar os níveis de não HDL-C em pacientes com diferentes graus de hipotireoidismo e o efeito da reposição de levotiroxina (LT4) nos níveis de não HDL-C em pacientes com HS. Métodos: Estudo seccional com 226 participantes estratificados em três grupos: (eutireoidismo - EU; hipotireoidismo subclínico - HS; hipotireoidismo manifesto - HM). Posteriormente, conduziu-se ensaio clínico randomizado duplo-cego e controlado com placebo por seis meses. Níveis de não HDL-C foram calculados como a diferença entre colesterol total e HDL-C. Resultados: Ocorreu discreta correlação positiva entre os níveis séricos de TSH e de não HDL-C (r=0,146; p=0,030). Observou-se correlação negativa entre os níveis...
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Hipotiroidismo/diagnóstico , Hipotiroidismo/economía , Factores de RiesgoRESUMEN
OBJECTIVE: The purpose of this study was to determine whether routine screening for subclinical hypothyroidism during pregnancy would be cost-effective. STUDY DESIGN: We developed a decision analysis model to compare the cost-effectiveness of 2 screening strategies during pregnancy for subclinical hypothyroidism: (1) no routine screening of serum thyroid-stimulating hormone (TSH) levels (standard) and (2) routine screening of TSH levels. In the latter, women with subclinical hypothyroidism received thyroid hormone replacement. We assumed that thyroid hormone replacement could reduce the incidence of an offspring IQ < 85 for pregnancies with subclinical hypothyroidism. The main outcome measure was marginal cost per quality-adjusted life year (QALY) gained. RESULTS: Our model predicts that universal screening is the dominant strategy. For every 100,000 pregnant women who were screened, $8,356,383 are saved, and 589.3 QALYs are gained. When subclinical hypothyroidism prevalence is reduced to 0.25%, screening remains cost-effective at $21,664/QALY gained. CONCLUSION: Screening for subclinical hypothyroidism in pregnancy will be a cost-effective strategy under a wide range of circumstances.
Asunto(s)
Hipotiroidismo/diagnóstico , Hipotiroidismo/economía , Tamizaje Masivo/economía , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/economía , Análisis Costo-Beneficio , Árboles de Decisión , Femenino , Humanos , Hipotiroidismo/epidemiología , Incidencia , Recién Nacido , Embarazo , Complicaciones del Embarazo/epidemiología , Prevalencia , Años de Vida Ajustados por Calidad de Vida , Tirotropina/sangreRESUMEN
STUDY OBJECTIVE: To explore gender differences in morbidity and total health care utilization 5 years prior to diagnosis of obstructive sleep apnea (OSA). DESIGN: Case-control study; patients were recruited between January 2001 and April 2003. SETTING: Two university-affiliated sleep laboratories. PATIENTS: 289 women (22-81 years) with OSA were matched with 289 men with OSA for age, body mass index (BMI), and apnea-hypopnea index (AHI). All OSA patients were matched 1:1 with healthy controls by age, geographic area, and primary physician. MEASUREMENTS AND RESULTS: Women with OSA compared to men with OSA have lower perceived health status and Functional Outcomes of Sleep Questionnaire score (54.5% vs. 28.4%, P <0.05 and 67.5+/-21.4 vs. 76+/-20.1, P <0.05, respectively). Compared to men with OSA, women with OSA have higher risk of hypothyroidism (OR 4.7; 95% CI, 2.3-10) and arthropathy (OR 1.6, 95% CI, 1.1-2.2) and lower risk for CVD (OR 0.7; 95% CI, 0.5-0.91). Compared to controls, both women and men with OSA had 1.8 times higher 5-year total costs (P <0.0001). Compared to men with OSA, expenditures for women with OSA are 1.3 times higher (P <0.0001). The multiple logistic regression (adjusting for BMI, AHI) revealed that age (OR 1.04; 95% CI, 1.01-1.07), antipsychotic and anxiolytic drugs (OR 2.3; 95% CI, 1.2-4.4), and asthma (OR 2.4; 95% CI, 1.1-5.6) are independent determinants for "most costly" OSA women. CONCLUSION: Compared to men with similar OSA severity, women are heavier users of health care resources. Low FOSQ score and poor perceived health status in addition to overuse of psychoactive drugs are associated with high health care utilization among women with OSA.
Asunto(s)
Recursos en Salud/estadística & datos numéricos , Apnea Obstructiva del Sueño/economía , Apnea Obstructiva del Sueño/epidemiología , Salud de la Mujer/economía , Adulto , Anciano , Artropatía Neurógena/economía , Artropatía Neurógena/epidemiología , Índice de Masa Corporal , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Gastos en Salud/estadística & datos numéricos , Recursos en Salud/economía , Humanos , Hipotiroidismo/economía , Hipotiroidismo/epidemiología , Israel/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Polisomnografía , Índice de Severidad de la Enfermedad , Distribución por SexoRESUMEN
OBJECTIVE: This investigation evaluated the cost-effectiveness of radioiodine remnant ablation following preparation with recombinant human TSH (rhTSH), compared with the standard preparation, whereby patients are rendered hypothyroid. DESIGN: The economic evaluation relates to patients with well differentiated thyroid cancer who have undergone thyroidectomy, but have no metastases. The evaluation takes a societal perspective, considering costs and benefits to all parties. The benefits were expressed in units of quality-adjusted life years (QALY), so differences in life expectancy were captured with consideration of quality of life. METHODS: A lifetime Markov model with Monte Carlo simulation of 100,000 patients was used to assess cost per QALY gained. The clinical inputs were sourced from a multi-centre, randomised controlled trial comparing remnant ablation success after rhTSH-preparation with hypothyroid preparation. The model applied German unit costs, however, the structure is generalisable to other jurisdictions. The additional cost of rhTSH procurement and administration is considered relative to the clinical benefits and cost offsets. These included avoidance of hypothyroidism, increased work productivity, earlier discharge from radioprotection and a theoretical reduction in the risk of secondary malignancy. The latter two benefits relate to faster radioiodine clearance after rhTSH preparation. RESULTS: The additional benefits of rhTSH (0.0495 QALY) are obtained with an incremental societal cost of 47 euro, equating to an incremental cost per QALYof 958 euro. Sensitivity analyses had only a modest impact upon cost-effectiveness, with all one-way sensitivity results remaining under 15,000 euro/QALY. CONCLUSIONS: The use of rhTSH prior to radioiodine ablation represents good value-for-money with the benefits to patient and society obtained at modest net cost.
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Hipotiroidismo/economía , Neoplasias de la Tiroides/economía , Neoplasias de la Tiroides/terapia , Tirotropina/uso terapéutico , Terapia Combinada , Análisis Costo-Beneficio , Eficiencia , Alemania , Estado de Salud , Humanos , Radioisótopos de Yodo/uso terapéutico , Cadenas de Markov , Modelos Económicos , Modelos Estadísticos , Método de Montecarlo , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Proteínas Recombinantes/uso terapéutico , TiroidectomíaRESUMEN
The study objective was to elucidate clinical, quality-of-life, and pharmacoeconomic effects of hypothyroidism secondary to thyroid hormone withdrawal (withdrawal) in athyroid patients with differentiated thyroid cancer (DTC). We also intended to compare societal costs of withdrawal and recombinant human thyroid-stimulating hormone administration (rhTSH) in this population. We mailed a 13-item pilot survey to patients with DTC who had undergone withdrawal before diagnostic whole-body scan (dxWBS). Using survey results and actual and estimated cost data, we retrospectively constructed a societal cost model comparing withdrawal versus rhTSH and performed a sensitivity analysis by increasing the conservatism of 8 assumptions about withdrawal costs. One hundred thirty (55%) of 236 patients answered the questionnaire. Among respondents, 92% had symptomatic and 85% multisymptomatic hypothyroidism. Almost half sought medical attention for hypothyroid complaints. Approximately one third drove motor vehicles while hypothyroid. Median absence from salaried work was 11 days per withdrawal. In the pharmacoeconomic model, societal costs per dxWBS were approximately 326 euro (25%) greater for withdrawal than for rhTSH. In the sensitivity analysis, societal costs of rhTSH exceeded those of withdrawal by approximately 307 euro (30%). In conclusion, hypothyroidism secondary to withdrawal causes important morbidity, safety risks, and productivity impairment. rhTSH avoids these drawbacks at roughly equivalent societal cost to that of withdrawal.
Asunto(s)
Hipotiroidismo/inducido químicamente , Hipotiroidismo/economía , Síndrome de Abstinencia a Sustancias , Neoplasias de la Tiroides/tratamiento farmacológico , Tirotropina/uso terapéutico , Tiroxina/efectos adversos , Adulto , Anciano , Economía Farmacéutica , Eficiencia/efectos de los fármacos , Femenino , Humanos , Hipotiroidismo/terapia , Radioisótopos de Yodo/uso terapéutico , Masculino , Persona de Mediana Edad , Modelos Económicos , Proyectos Piloto , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Seguridad , Encuestas y Cuestionarios , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/radioterapiaAsunto(s)
Terapia de Reemplazo de Hormonas , Hipotiroidismo/tratamiento farmacológico , Tiroxina/uso terapéutico , Autoanticuerpos/sangre , Análisis Costo-Beneficio , Femenino , Terapia de Reemplazo de Hormonas/economía , Humanos , Hipotiroidismo/economía , Yoduro Peroxidasa/inmunología , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Tiroiditis Autoinmune/complicaciones , Tirotropina/sangre , Tiroxina/economíaRESUMEN
OBJECTIVE: To analyze the clinical, biochemical and epidemiological characteristics in patients with hypothyroidism, substitutive dose and annual direct costs, in a health area. MATERIAL AND METHODS: Seventy five patients attended in a health area were included in the review. Data was divided in epidemiological, biochemical, clinics and economics. RESULTS: A 94.7% were females and 5.3% males, with an average age of 52.07 + 16.5 years. The most frequent disease was Thyroiditis of Hashimoto 48% and atrophic thyroiditis 46.6%. Average value of TSH was 17.57 + 40.8 mUI/ml and TPO 629.3 + 1049 UI/ml and Ac TG 532.1 + 1028 UI/ml. A 58.7% of patients had goiter, only evident 2.6%. The average dose of T4 was 81 + 53.5 mg/day. The average number of visits was 2.67 + 1.08. The highest cost was due to specialists visit 160 + 65 euros with a total average cost of 212.9 + 81.5 euros. Levels of TPO was higher in T. Hashimoto, with a higher number of visits and costs. CONCLUSIONS: The most prevalent disease was autoimmune (T Hashimoto and atrophic thyroiditis) with higher levels of TPO in Hashimoto. Total cost is higher in T. Hashimoto.