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Mark D. Danese, MHS; Neil R. Powe, MD, MPH, MBA; Paul W. Ladenson, MD
The Johns Hopkins University Baltimore, Md

Clark T. Sawin, MD
Boston University School of Medicine Boston, Mass

JAMA. 1996;276(19):1550-1551.

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In Reply.

—Drs Welch and Birkmeyer highlight 2 important points in our analysis of screening for mild thyroid failure. The first point is that the utility (or health-related quality of life) for patients with mild thyroid failure may be too low at 0.90. It is important to recognize that only 28% of patients with mild thyroid failure (high TSH and normal free thyroxine levels) were assigned a utility of 0.90 and considered to have some reversible symptoms of thyroid hormone deficiency. The remaining 72% of patients were assumed to have maximum quality of life. Thus, the average utility for patients in the state of mild thyroid failure is 0.97, not 0.90. However, even this conservative estimate does not negate the fact that the utility of mild thyroid failure with symptoms is an important issue in screening. In sensitivity analyses, this variable was second only to the cost of the TSH assay in . . . [Full Text PDF of this Article]

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