A preliminary cost-utility analysis of routine myasthenia gravis and thyroid dysfunction screening in acquired comitant Esotropia

28 May 20264 min read0 viewsJournal Feed

GIST (Key Takeaways)

by Worapot Srimanan, Phawasutthi Keokajee, Sunita Sawangsribanterng This study evaluated the cost-effectiveness of routine screening for acetylcholine receptor antibody (AChR-Ab) and thyroid function tests (TFT) in patients with acquired comitant esotropia (ACE) without overt signs of myasthenia gravis (MG) or thyroid eye disease (TED). A retrospective cost–utility analysis was conducted in 110 patients at a Thai tertiary hospital between 2014 and 2024.
A decision tree combined with a 10-year Markov model compared two strategies: no routine screening (symptom-triggered testing) and universal baseline screening with AChR-Ab and TFT. Costs were expressed in 2024 Thai Baht (THB) from a healthcare sector perspective, and outcomes were measured in quality-adjusted life years (QALYs).
Model uncertainty was assessed using one-way sensitivity analyses and probabilistic sensitivity analysis with 10,000 simulations, incorporating downstream costs of follow-up, confirmatory evaluation, and treatment. In the base-case analysis incorporating real-world diagnostic accuracy, universal screening yielded higher QALYs (109.56 vs.
105.45) but also higher costs (฿2,826,680 vs. ฿1,653,500), resulting in an incremental cost-effectiveness ratio (ICER) of ฿285,360 per QALY gained.

Clinical Editorial

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PLOS ONE (Medicine) published a clinical update in Research Highlights on 28 May 2026.

The item focuses on A preliminary cost-utility analysis of routine myasthenia gravis and thyroid dysfunction screening in acquired comitant Esotropia.

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