{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:04:22Z","timestamp":1765818262524,"version":"3.48.0"},"reference-count":16,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,7,8]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We examined whether it is cost-effective to measure free thyroxine (FT4) in addition to thyrotropin (thyroid-stimulating hormone (TSH)) on all requests for thyroid function tests from primary care on adult patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypopituitarism occurs in about 4 people per 100\u2009000 per year. Loss of thyrotropin (TSH) secretion may lead to secondary hypothyroidism with a low TSH and low FT4, and this pattern may help to diagnose hypopituitarism that might otherwise be missed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Markov model simulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>Incremental cost-effectiveness ratio (ICER), the ratio of cost in pounds to benefit in quality-adjusted life years of this strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ICER for this strategy was \u00a371\u2009437. Factors with a large influence on the ICER were the utilities of the treated hypopituitary state, the likelihood of going to the general practitioner (GP) and of the GP recognising a hypopituitary patient. The ICER would be below \u00a320\u2009000 at a cost to the user of an FT4 measurement of \u00a30.61.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With FT4 measurements at their present cost to the user, routine inclusion of FT4 in a thyroid hormone profile is not cost-effective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-029369","type":"journal-article","created":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T05:45:17Z","timestamp":1564465517000},"page":"e029369","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["In primary care, is measuring free-thyroxine plus thyroid-stimulating hormone to detect hypopituitarism cost-effective? A cost utility analysis using Markov chain models"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1016-8638","authenticated-orcid":false,"given":"Brian","family":"Shine","sequence":"first","affiliation":[{"name":"Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"James","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Adler","sequence":"additional","affiliation":[{"name":"Institute of Metabolic Sciences, Addenbrooke's Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,29]]},"reference":[{"key":"2025121509003972000_9.7.e029369.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb01894.x"},{"key":"2025121509003972000_9.7.e029369.2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2001.01406.x"},{"key":"2025121509003972000_9.7.e029369.3","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2007.007100"},{"key":"2025121509003972000_9.7.e029369.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03534.x"},{"key":"2025121509003972000_9.7.e029369.5","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3787"},{"key":"2025121509003972000_9.7.e029369.6","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmv010"},{"key":"2025121509003972000_9.7.e029369.7","unstructured":"NICE , 2018. 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Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/datasets\/the21stcenturymortalityfilesdeathsdataset [Accessed 2017]."},{"key":"2025121509003972000_9.7.e029369.11","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.1365-2265.2007.03010.x","article-title":"Growth hormone (GH) replacement in hypopituitary adults with GH deficiency evaluated by a utility-weighted quality of life index: a precursor to cost-utility analysis","volume":"68","author":"Ko\u0142towska-H\u00e4ggstr\u00f6m","year":"2008","journal-title":"Clin Endocrinol"},{"key":"2025121509003972000_9.7.e029369.12","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1177\/0272989X16670617","article-title":"Estimation of survival probabilities for use in cost-effectiveness analyses: a comparison of a multi-state modeling survival analysis approach with partitioned survival and Markov decision-analytic modeling","volume":"37","author":"Williams","year":"2017","journal-title":"Med Decis Making"},{"key":"2025121509003972000_9.7.e029369.13","doi-asserted-by":"publisher","DOI":"10.1177\/000456329503200502"},{"key":"2025121509003972000_9.7.e029369.14","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1055\/s-0035-1559782","article-title":"Should free thyroxine go back into the routine thyroid profile?","volume":"123","author":"Livingston","year":"2015","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"2025121509003972000_9.7.e029369.15","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-015-0636-7"},{"key":"2025121509003972000_9.7.e029369.16","unstructured":"Lord Carter of Coles . Report of the review of NHS pathology services in England, 2006. Available: http:\/\/webarchive.nationalarchives.gov.uk\/20061003103150\/http:\/\/www.dh.gov.uk\/PublicationsAndStatistics\/Publications\/PublicationsPolicyAndGuidance\/PublicationsPolicyAndGuidanceArticle\/fs\/en?CONTENT_ID=4137606&chk=J4t5ZX"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-029369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:00:47Z","timestamp":1765818047000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-029369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7]]},"references-count":16,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7,29]]},"published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1136\/bmjopen-2019-029369"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-029369","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2019,7]]}}}