PDB51 PREVENTION AS A PUBLIC HEALTH MEASURE: LONG-TERM EFFECTIVENESS AND COST EFFECTIVENESS OF A POPULATION-BASED IODINE DEFICIENCY DISEASES PREVENTION PROGRAM

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Iodine deficiency can lead to different diseases, such as goiter, stillbirth and mental impairment of newborns. A population-based prevention program may eliminate iodine deficiency, but might also come with harms, such as increasing the prevalence of hyperthyroidism. We aimed to evaluate the cost effectiveness of a population based prevention program for iodine deficiency disorders (IDD). We developed a state-transition open cohort model to project the health and economic consequences of an IDD prevention program (i.e., iodine fortification of salt) in a hypothetical population with moderate iodine deficiency in the German context. Model parameters were derived by literature reviews, experts’ estimations or model calibration methods. Direct medical and non-medical costs were included (Euro 2018). Costs were derived from different sources: German DRG System, official medical fees, and Lauer Taxe. Indirect costs were considered in an additional analysis. We compared incremental life years (LY), incremental quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICER) of prevention and no prevention. Health effects and costs were discounted at 3% annually. Model validation was performed. We analyzed three different scenarios: (1) open cohort over a time horizon of 120 years; (2) newborn cohort over their lifetime; (3) current live population over their lifetime, without consideration of new births. Additionally, we performed multiple one-way sensitivity analyses. In all three scenarios, the prevention was dominant compared to no prevention. Increments in quality-adjusted life expectancy ranged from 0.04 to 0.16 QALYs per person (0 to 0.01 LYs). For the currently live population in Germany (82,792,351), 0.04 QALYS amount to 3,311,694 QALYs gained. Cost savings ranged from EUR 522 to 14,624 per person. The prevention program remained dominant in most of the sensitivity analyses. Prevention of IDDs with iodine fortification of salt could be a cost-effective public health intervention for a moderately iodine deficient population.