Health State Utilities In Individuals With Goiter, Hypothyroidism, Hyperthyroidism And Graves' Disease As An Example For Thyroid Disorders - A Systematic Review

A wide spectrum of illnesses due to iodine deficiency is termed as iodine deficiency disorders (IDD). IDD include thyroid diseases, such as goiter, hypothyroidism and hyperthyroidism. However, iodine excess can also provoke thyroid diseases, such as Graves’ disease. IDD and related consequences negatively affect quality of life. Our aim was to identify utilities, reflecting health-related quality of life, for health states associated with thyroid disorders. We conducted a comprehensive systematic literature search in Medline and Tuft’s CEA Registry to identify relevant published literature. Studies were required to report on health-related utilities in individuals with hypothyroidism, hyperthyroidism, goiter or Graves’ disease. Results were summarized in evidence tables including information about population, original source, and methods for utility estimation. Overall, we found 944 studies. After title/abstract and full-text screening, eleven studies were included. We found utilities for different ages, treatments, treatment sequelae. Utilities for hypothyroidism were dependent on population and therapeutic options. The range was 0.469 (unscreened newborns) to 1 (treated subclinical hypothyroidism in adults). Utilities for hyperthyroidism dependend on treatment. The range was 0.467 (without treatment) to 0.98 (euthyroid with anti-thyroid drugs). For goiter, we found utilities for the condition after thyroidectomy (0.81). Utilities for Graves’ disease ranged from 0.85 (screened pregnant woman) to 0.88 (Graves’ ophthalmopathy). Health utilities were collected using different outcome measurements including time-trade-off, standard gamble, Health Utilities Index MARK 2, and expert opinion. In several studies, utilities were derived from literature and data were originally collected for medical conditions unrelated to thyroid diseases. We identified studies reporting on utilities for different health states related to thyroid diseases. However, there is a lack of robust estimates on utility decrements. Future studies should incorporate the collection of utilities for application in decision-analytic models for the evaluation of the benefit-harm ratio of IDD prevention strategies.