Trends in costs and prescribing for liothyronine and Levothyroxine in England and Wales 2011-2020

[helvella]

Hopefully, this doesn't repeat an existing post.

Trends in costs and prescribing for liothyronine and Levothyroxine in England and Wales 2011-2020

Mike Stedman 1 , Peter Taylor 2 , Lakdasa Premawardhana 2 , Onyebuchi Okosieme 2 , Colin Dayan 2 , Adrian H Heald 3 4

Affiliations

• PMID: 33411974

• DOI: 10.1111/cen.14414

Abstract

Introduction: Recent prescribing policies in England and Wales have imposed significant restrictions on liothyronine prescribing in general practice driven by the prohibitive costs and uncertain benefits of liothyronine in the management of hypothyroidism. However, the impact of these policies on liothyronine usage and costs are still unclear.

Methods: Data was downloaded from the NHS monthly General Practice Prescribing Data in England and from the Comparative Analysis System for Prescribing Audit (CASPA) in Wales for 2011-2020. Trends over the period in amount and costs of levothyroxine, and liothyronine prescribing were analysed.

Results: The total medication costs per year for England Wales for hypothyroidism rose from £60.8million to £129.8million in 2015-16 and have since reduced to £88.4million. Levothyroxine prescriptions have been growing above the population growth rate at 0.7%/annum in England and 1.1% in Wales. The costs/patient/year for liothyronine rose from £550 to £3,000 in 2015-16 and have since fallen to £2,500. Use of liothyronine as a percentage of levothyroxine started to fall in 2015-16 at 7%/annum in England and 3% in Wales. Nevertheless 0.5% of levothyroxine treated patients continue to receive liothyronine. All Clinical Commission Groups (CCGs) in England continue to have at least one liothyronine prescribing practice and 48.5% of English general practices prescribed liothyronine in 2019-20.

Conclusion: In spite of strenuous attempts to limit prescribing of liothyronine in general practice a significant number of patients continue to receive this therapy. The price differential of liothyronine vs levothyroxine should be examined again in light of the continuing use of liothyronine.

Keywords: T3; T4; comparison; levothyroxine; liothyronine; prescribing; trends.

Full article is behind a paywall:

pubmed.ncbi.nlm.nih.gov/334...

[Hennerton]

I am sure everyone knows that Liothyronine can be bought in France, Greece, etc for a few euros. It is disgraceful that nothing has been done by the NHS procurement department to address this.

[Lulu2red in reply to Hennerton]

Not without a prescription though and not since Brexit!

[Hennerton in reply to Lulu2red]

My point is that other countries manage to buy it at a reasonable price. Why cannot we?

[TSH110]

I just wonder why the inflated price of Liothyronine has been allowed to persist. If it were a fair price all this grotesque rationing - with no heed paid to the very people with the condition and best able to judge the efficacy of any treatment they get, coupled with an ever growing body of research that probes and finds wanting the glib statement ‘uncertain benefit of liothyronine in the management of hypothyroidism‘ - might be somewhat more difficult to justify.

The last thing we need is further attempts to restrict its use.

[Lulu2red]

There is a conspiracy going on behind the scenes, I think Endocrinologists must all own shares in T4, after all T3 is cheap as chips to make. I have to be faulty DI02 gene but I remain hypothyroid on T3 only 60mg per day in split doses. I am pushing for an increase but because my Free T3 is 44% through the range they deem it enough. I would increase by myself if I had the money to get a private prescription. They know I am still hypothyroid because I cannot lose weight, have no appetite, no energy, my nails etc but they think we should just lump it. I also think people who don't need T3 have abused it for weight loss and given it a bad name i.e. celebraties, weight lifters and of course the late great Mohammed Ali. They only reason I survived is that I did manage to convert a tiny amount of T3 from T4 but it took 250 micrograms to do it. I sleep walked through my life for 20 years on T4. It's basically medical neglect. They wouldn't refuse insulin to a type one diabetic! I think we need to take legal action as a group in the UK, it's the only way they will change their prescribing. We need to stand up to them. Hypothyroidism is not a hidden disease, signs and symptoms are just ignored and the blood test is complete nonsense. Every individual has their own optimal thyroid levels and no one knows what they are. You just need to increase your medication until you feel better. What annoys me is my friend has hyperthyroidism and her blood levels are way off the scale but the no one is forcing her to treat it. GP says it's up to you. She is happy having lots of energy and being able to eat huge amounts and stay slim. But I am not allowed an increase in my T3 to get my health back because of the price. If it were the same price as T4 I would have got my life back by now!

[vocalEK]

Someone should do a study regarding the effectiveness of liothyronine in correcting high cholesterol and depression. The costs of medications to treat both of these could be compared in people having T3 added to their treatment versus those with FT3 low in, or under, range who are not given liothyronine. When T3 was added to my hypothyroidism treatment, my cholesterol went down into the normal range and I was able to titrate down and off the antidepressant medication I had been taking for 20 years.