PMID: 2105384Jan 1, 1990Paper

The cost-effectiveness of three thyroid function testing strategies for suspicion of hypothyroidism in a primary care-setting

Journal of General Internal Medicine
J M Schectman, L G Pawlson

Abstract

To determine the sensitivity and specificity of thyroxine (T4) and the cost-effectiveness of three testing strategies in the diagnosis of hypothyroidism in a primary care setting. 1) A retrospective chart review to determine sensitivity and specificity of T4 in diagnosing hypothyroidism; a cost-effectiveness analysis comparing ordering an initial T4 test alone, an initial thyroid-stimulating hormone (TSH) test alone, and T4 and TSH tests together in diagnosing hypothyroidism; a sensitivity analysis was performed on critical assumptions. Primary care adult practice of a health maintenance organization. Eight hundred sixteen consecutive patients suspected of having hypothyroidism who had both T4 and TSH tests performed. None. The sensitivity of a T4 cut-off of 7 micrograms/dl (90.3 nmol/L) in diagnosing primary hypothyroidism was 93% (95% confidence interval = 85-100%) and the specificity was 68% (95% confidence interval = 65-71%). The cost-effectiveness ratios of using an initial T4 or TSH test were about the same across a wide range of test characteristics and disease prevalence estimates. As the ratio of T4 to TSH test charges declines from 0.6 to 0.2, the marginal cost of the TSH-first method increases from $3,500 to $18,000 ...Continue Reading

References

Mar 1, 1979·Clinics in Endocrinology and Metabolism·R Capiferri, D Evered
Jul 20, 1979·JAMA : the Journal of the American Medical Association·C T SawinP Bacharach
Dec 1, 1977·Clinical Endocrinology·W M TunbridgeP A Smith
Apr 1, 1989·Archives of Internal Medicine·J M SchectmanR P Hirsch
May 18, 1985·Lancet·G CaldwellA D Toft
Mar 1, 1986·Journal of Clinical Pathology·C M Corns, A L Miller
Oct 1, 1988·Mayo Clinic Proceedings·E C Ridgway
Jan 1, 1987·Journal of General Internal Medicine·B J Goldstein, A I Mushlin
Jul 10, 1987·JAMA : the Journal of the American Medical Association·M J RosenthalJ S Goodwin
Sep 1, 1985·The Medical Clinics of North America·C T Sawin
Sep 1, 1985·Annals of Clinical Biochemistry·J S Woodhead, I Weeks
Mar 1, 1985·American Journal of Clinical Pathology·J P NolanG DiBenedetto
Mar 17, 1973·British Medical Journal·D C EveredT Bird
Jan 29, 1972·British Medical Journal·D Evered, R Hall
Nov 17, 1984·Lancet·G Caldwell, A D Toft
Aug 1, 1984·Journal of the American Geriatrics Society·L E HeikoffL Z Feigenbaum
Jan 24, 1981·British Medical Journal·W M TunbridgeE Young

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Citations

Feb 1, 1996·Journal of General Internal Medicine·P A Masters, R J Simons
Oct 1, 1992·Journal of the American Academy of Nurse Practitioners·J L Johnson, J V Felicetta
Jun 14, 2018·Thyroid : Official Journal of the American Thyroid Association·Kevin RoConnie M Rhee
Jan 23, 2020·Thyroid : Official Journal of the American Thyroid Association·Ursula RochauUwe Siebert
Jan 1, 1997·The Physician and Sportsmedicine·W D KnoppJ C McCoy
Feb 1, 1992·QRB. Quality Review Bulletin·J M SchectmanL G Pawlson

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