The economic impact of prevention, monitoring and treatment strategies for iodine deficiency disorders in Germany

Objective: More than 30% of the German population suffers from mild to moderate iodine deficiency causing goiter and other iodine deficiency disorders (IDDs). The economic burden of iodine deficiency is still unclear. We aimed to assess costs for prevention, monitoring and treatment of IDDs in Germany. Design: We performed a comprehensive cost analysis. Methods: We assessed direct medical costs and direct non-medical costs for inpatient and outpatient care of IDDs and costs for productivity loss due to the absence of work in 2018. Additionally, we calculated total costs for an IDD prevention program comprising universal salt iodization (USI). We performed threshold analyses projecting how many cases of IDDs or related treatments would need to be avoided for USI to be cost-saving. Results: Annual average costs per case in the year of diagnosis were (sic) 211 for goiter/thyroid nodules; (sic) 308 for hyperthyroidism; and (sic) 274 for hypothyroidism. Average one-time costs for thyroidectomy were (sic) 4184 and (sic) 3118 for radioiodine therapy. Average costs for one case of spontaneous abortion were (sic) 916. Annual costs of intellectual disability were (sic) 14,202. In the German population, total annual costs for USI would amount to 8 million Euro. To be cost-saving, USI would need to prevent, for example, 37,900 cases of goiter/thyroid nodules. Conclusion: USI potentially saves costs, if a minimum amount of IDDs per year could be avoided. In order to recommend the implementation of USI, a full health-economic evaluation including a comprehensive benefit-harm assessment is needed.