Cost estimation of thyroid disorders in Germany.

To assess the economic effects of thyroid disorder-related morbidity in Germany, a systematic review of national and international literature from 1981-2001 was performed. Data from insurance companies, the government department of public health, and the federal office of statistics helped characterize the situation in Germany. Being the most important thyroid disease, endemic iodine-deficiency goiter causes economic costs of approximately 2.1 billion DM per year or 1 billion Euros or 1 billion U.S. dollars. In recent years iodine supplementation of food became better accepted by the German population. This should significantly reduce the prevalence of goiter from 30%-40% to less than 10%. Functional thyroid disorders are observed in 5%-10% of the German population. A more differentiated view of these conditions should lead to specific guidelines for an economic screening and therapy of subpopulations. Lacking valuable data, an actual economic assessment of autoimmune or malignant thyroid diseases cannot be performed. On the other hand, with respect to the costs of specific thyroid therapy, e.g., radioiodine treatment of thyrotoxicosis (mainly toxic nodular goiter), the economic consequences of a new regulation for radiation protection in Germany have been demonstrated recently. Using the actual maximum permissible level of residual activity on discharge from the hospital after radioiodine therapy, length of hospitalization was shortened to 5.1 days in university hospitals and to 5.8 days in nonuniversity institutions. Payment per patient for radioiodine therapy was 1,856 and 1,530 Euros (median value) in university and nonuniversity hospitals, respectively. In conclusion, better prevention of iodine deficiency and its long-term consequences should effectively reduce direct as well as indirect costs and overall economic impact of endemic goiter as the most important thyroid disease in Germany. Sustainable elimination of iodine deficiency is technically possible, but it needs further commitment and support at all levels.