Thanks Jonathan.
We carried out a pilot study looking into this at Oxford and made an estimate of ICER based on in-house data on workload figures, unit test costs etc. as well as data from the literature on prevalence, QoL in treated and untreated hypopit patients and differences in mortality rates. Based on our calcs, FT4 as a first-line test for GPs was deemed not to be cost-effective (ICER=£39,000/QALY; NICE use a cut-off of about £20,000/QALY). A few assumptions had to be made, so the ICER we calculated is an estimate. We also performed sensitivity analyses to look what effect varying the different parameters had on the ICER (as a % change) e.g. halving the test cost for FT4.
This was presented by Dr Shine at the ACB SR Spring meeting held in April and also as a poster at this year's FOCUS meeting. If anyone would like a copy of the pdf I am happy to email it.
Sharon
Sharon Colyer
Pre-registration Clinical Biochemist
Clinical Biochemistry
Royal Free Hospital
Ext 38856
-----Original Message-----
From: Jonathan Kay [mailto:[log in to unmask]]
Sent: 21 June 2013 20:24
To: [log in to unmask] (general)
Cc: [log in to unmask]
Subject: Re: Looking for hypopituitarism
... or even T4, but you know what I meant.
Jonathan
On 21 Jun 2013, at 20:17, Jonathan Kay wrote:
> Why are we still discussing optimal strategies for thyroid-related investigations around anecdotes of individual patients? It shouldn't be too hard to work out if doing that TSH is worth it or not. You'd need some estimates of prevalence of undiagnosed hypopituitarism, benefit of detecting and treating it, disbenefits around patients who have to be investigated further but turn out not to need intervention, a few unit costs etc. Then you could work out something like incremental cost-effectiveness ratio in £/ QALY, and numbers needed to investigate.
>
> Or perhaps someone has already done this, and presented it?
>
> Jonathan
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