Analytical approach:
A decision tree was used to synthesise clinical and cost data to enable a comparison of the strategies. The analysis was conducted using a lifetime horizon. The authors reported that point of view was that of the caregiver.
Effectiveness data:
Screening data were obtained from 34,007 neonates in Central Health Laboratory of Tehran University of Medical Sciences in 2009 and 2,310 with heel prick tests of TSH above 5mU/L were recalled for further tests and 1,197 were tested. Tests revealed that 39 neonates had congenital hypothyroidism using the lab criteria of TSH of 10mU/L or more. Incidence of congenital hypothyroidism was considered equal in males and females. Other data included the number of permanent and transient cases of congenital hypothyroidism, programme coverage, false-negative rates, mortality rates and incidence.
Monetary benefit and utility valuations:
Not relevant
Measure of benefit:
The summary measure of benefit was disability adjusted life years (DALY). Disability weight used was similar to that of Down's Syndrome, citing a local reference study of disease burden.
Cost data:
Data were derived from a local study and Ministry of Health and State Welfare Organization data. Cost categories included were screening, confirmatory test, general and specialised physician visits, drugs, periodic laboratory tests, education and care of mentally retarded patients.
Analysis of uncertainty:
For sensitivity analysis, each input parameter changed ±1SD and its effect on ICERs (incremental cost-effectiveness ratios), incremental costs and incremental effects were calculated and shown by tornado plots. Probabilistic analysis was performed by Monte Carlo simulation using a cohort of 10,000 neonates (5,000 females and 5,000 males). Selected distributions were described.