Cost-of-illness studies (COI) can identify and measure all the costs of a particular disease, including the direct, indirect and intangible dimensions. They are intended to provide estimates about the economic impact of costly disease. Alzheimer disease (AD) is a relevant example to review cost of illness studies because of its costliness.The aim of this study was to review relevant published cost studies of AD to analyze the method used and to identify which dimension had to be improved from a methodological perspective. First, we described the key points of cost study methodology. Secondly, cost studies relating to AD were systematically reviewed, focussing on an analysis of the different methods used. The methodological choices of the studies were analysed using an analytical grid which contains the main methodological items of COI studies. Seventeen articles were retained. Depending on the studies, annual total costs per patient vary from $2,935 to $52, 954. The methods, data sources, and estimated cost categories in each study varied widely. The review showed that cost studies adopted different approaches to estimate costs of AD, reflecting a lack of consensus on the methodology of cost studies. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable.

Thyroid dysfunction is the second most common endocrinopathy affecting women of childbearing age. Many studies have recommended that thyroid function screening should be routinely performed in all pregnant women. The aim of the present study was to determine the prevalence of thyroid disorders during pregnancy and to evaluate efficiency of the universal screening strategy versus case-finding strategy for diagnosing thyroid dysfunctions. METHODS: Comprehensive literature search was done in PubMed and EMBASE databases till July 2012 for studies related to prevalence and screening of thyroid dysfunction. For prevalence, the primary estimate was weighed mean pooled prevalence (%) with 95% CI. For screening, the primary estimate was pooled odds ratio (OR) with 95% CI. Heterogeneity was assessed by I 2 statistics. Publication bias was assessed using Begg and Egger test. Sensitivity analysis was also performed. RESULTS: A total of 33 studies (1988-2012) for prevalence and 5 (2007-2011) for screening were found to be pertinent. Because of significant heterogeneity, a random effects model was chosen. Combined analysis of weighed pooled prevalence of 19 studies of Thyroid Auto Immunity found 9.7% (9.5-10), 21 studies of hypothyroidism found 3.7% (2.2-6.1) and 10 studies of hyperthyroidism found 2.2% (1.0-4.5), 7 studies of overt/ clinical hypothyroidism found 2% (0.8-5.1), 13 studies of subclinical hypothyroidism found 3.7% (3-4.7), 6 studies of hypothyroxinemia found 3.4% (1.2-9.8), 4 studies of overt/ clinical hyperthyroidism found 0.6% (0.3-1.4) and 5 studies of subclinical hyperthyroidism found 0.022 (1.6-2.9). For the effectiveness of universal screening pooled OR was found to be 2.87 (1.60-4.94, P-<0.001). CONCLUSIONS: Our analysis supports the hypothesis of higher prevalence of thyroid dysfunction in pregnancy especially, hypothyroidism. The universal screening strategy is found to be more effective as the case-finding strategy fails to detect the majority of pregnant women with thyroid dysfunction.

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