Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism findings from health insurance claims data.docVIP

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Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism findings from health insurance claims data.doc

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Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism findings from health insurance claims data

Kemperetal.BMCPediatrics2010,10:9 /1471-2431/10/9 RESEARCH ARTICLE OpenAccess Discontinuationofthyroidhormonetreatment amongchildrenintheUnitedStateswith congenitalhypothyroidism:findingsfromhealth insuranceclaimsdata AlexRKemper1*,LijingOuyang2,ScottDGrosse2 Abstract Background:Thyroidhormonetreatmentinchildrenwithcongenitalhypothyroidismcanpreventintellectual disability.Guidelinesrecommendthatchildrendiagnosedwithcongenitalhypothyroidismthroughnewborn screeningremainontreatmenttoatleast3yearsofage,afterwhichatrialofftherapycandeterminewhich childrenhavetransienthypothyroidism.Thepurposeofthisstudywastodescribetherateatwhichchildrenwith congenitalhypothyroidismintheUnitedStatesdiscontinuethyroidhormonetreatmentinearlychildhood. Methods:Retrospectiveanalysisofthe2002-2006MarketScan?CommercialClaimsandEncountersresearch databasesandthe2001-2005MarketScanMulti-StateMedicaiddatabases.Childrenwereclassifiedashaving congenitalhypothyroidismbasedonbillingcodesandhavingfilledaprescriptionforthyroidhormonetreatment. Kaplan-Meiercurveanalysiswasusedtodeterminediscontinuationrates. Results:Therewereatotalof412Medicaid-enrolledchildrenand292privately-insuredchildrenwithpresumed congenitalhypothyroidismincludedinthisstudy.Theoverallbirthprevalenceofcongenitalhypothyroidismacross bothdatasetswasabout1per2,300.By36months,thepercentagewhohaddiscontinuedthyroidreplacement treatmentwas38%(95%ConfidenceInterval:32%-44%).Medicaid-enrolledchildrenhadamorerapiddeclinein thefirst24monthsoftreatmentcomparedtothosewithprivateinsurance(P=0.02). Conclusions:Morethanone-thirdofchildrentreatedforcongenitalhypothyroidismdiscontinuedtreatmentwithin 36months,whichisinconsistentwithcurrentguidelines.Itisnotknownhowmanyofthesechildrenrequired continuedtreatmentorexperienceadverseeffectsfromdiscontinuation.Thesefindingsemphasizethecriticalneed forfollow-upsystemstomonitortheoutcomeofnewbornscreening. Background includedinnewbornscreeningandbecausetreatmentis Althoug