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Monika Schaffner, Ursula Rochau, Nikolai Mühlberger, Annette Conrads-Frank, Vjollca Qerimi-Rushaj, Gaby Sroczynski, Eftychia Koukkou, Betina Heinsbaek, Henry Volzke, Wilhelm Oberaigner, and Uwe Siebert

Objective: More than 30 percent 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 absence of work in 2018 Euro. 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 EUR 211 for goiter/thyroid nodules; EUR 308 for hyperthyroidism; and EUR 274 for hypothyroidism. Average one-time costs for thyroidectomy were EUR 4,184 and EUR 3,118 for radioiodine therapy. Average costs for one case of spontaneous abortion were EUR 916. Annual costs of intellectual disability were 14,202 Euro. 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.