Medicare Coverage of Routine Screening for Thyroid Dysfunction (2003) / Chapter Skim
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6. Conclusions and Recommendations
6. Conclusions and Recommendations
Pages 69-72
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From page 69... ...
Based on existing data and analyses of Medicare data performed under contract, the Committee first turned to the question about whether there were obvious deficits in access to thyroid function tests and thyroid care in the absence of a policy allowing periodic screening. Based on this evidence, the Committee concludes that current Medicare coverage of thyroid function testing does not impede the timely diagnosis of thyroid disease.
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From page 70... ...
It is uncertain whether asymptomatic persons with abnormal TSH levels but normal thyroid hormone levels actually have some degree of physiologically meaningful abnormalities that would benefit from early treatment in the absence of clinical manifestations. While a few general, small studies suggest that some "asymptomatic" persons with altered TSH levels have detectable physiological or anatomic abnormalities, questions concerning the factors selecting these individuals for study, how these persons relate to defined populations, and whether these intermediate outcomes presage worse overall morbidity and mortality rates compared to appropriate contrast groups leave doubt as to the significance of these findings.
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From page 71... ...
Thus, the Committee concluded Conclusion #2: Given insufficient evidence about the health benefits of a serum TSH screening program, the cost implications for the Medicare program are uncertain. Because evidence is lacking on the likely health benefits of screening, there is no reasonable basis for estimating whether a screening program would detect thyroid dysfunction more effectively than usual care and, hence, how the costs of treating thyroid dysfunction under the alternative strategies would compare.
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From page 72... ...
Because of the large number of older persons who possess biochemical thyroid abnormalities, screening and treating for these abnormalities could generate substantial benefit or harm at considerable financial cost. Randomized, controlled trials of TSH screening, pragmatic in approach, could assess the effectiveness of screening and treatment obtained under usual community conditions and consider both health and economic outcomes.
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