analysis of cost/ benefit of liothyronine

[Mollyfan]

I am not sure if this has been posted before but I found it interesting reading. An insight into how some decisions are made ( or not!)

bmjopen.bmj.com/content/11/...

[GlowCoach Administrator]

Our survey indicated their mean utility value is 0.53 which makes these individuals comparable in terms of their health status, to patients with lung cancer, or acute cerebrovascular disease and would rank in the bottom decile of 100 chronic diseases.

They know all this yet still procrastinate.

Also, they are still banging on about TSH. Give me strength.

[Mollyfan in reply to GlowCoach]

Exactly….. that is the sentence I was going to highlight ( crap computer skills!).

At least the authors are trying to highlight the potential benefits of T3 and actually look at the cost in terms of quality of life as they do for other diseases.

[GlowCoach Administrator in reply to Mollyfan]

They seem to be talking themselves round in circles. Wish they'd actually get on and do something..

[tattybogle]

Very interesting .. thankyou Mollyfan .

I wonder what this would look like if they updated it for current T3 prices.. it's based on 28 tables being £165 in 2018/2019.. but much cheaper T3 options are available to NHS today .

think it's about £55 now for Roma .

[SlowDragon Administrator in reply to tattybogle]

I was just going to say exactly the same

Typical cost TODAY if someone on 20mcg per day is £56 per month not £165

[helvella in reply to SlowDragon]

Most of that paper should have been replaced by a demand that a medicine from 1956, that is inherently fairly inexpensive, must not have prescribing decisions made on the basis of grossly inflated (and unjustifiable) prices.

The rest should have been written from the point of view of the basic cost of T3 being similar to that of T4. That is, a "level playing field" of efficacy and health rationale.

[Mollyfan]

absolutely….. it would seem to be a no brainier now lio is so much cheaper. I wonder if certain rigid endocrinologists would accept this or are they so fixed that nothing will move them?

[SmallBlueThing]

"a case–control study of patients taking long-term liothyronine found no evidence of additional risk of atrial fibrillation, cardiovascular disease or fractures, following adjustment for age. The TSH concentrations of these patients were within normal range (median 1.07 mU/L)."

Interesting that the median TSH for those patients was that high, no?

[buddy99]

What caught my eye was that the often quoted dangers of going even slightly below interval in this paper only start at TSH <0.03 which is a far cry from, let's say, 0.37 (interval 0.4-4) that always prompted doctors to lower my dose. Otherwise the paper is full of interesting information. I will have to read it a couple of times to glean all of the hidden nuggets. Thanks for posting, Mollyfan.

[diogenes Remembering]

What I don't like about this is simply basing patient treatment on a narrow cost/benefit statistical analysis. The number of patients needing T3 is not small, and so the decision outcome should be very different from a patient with a very rare disease and costly treatment. The true analysis should include the social aspect. How many patients can no longer work because of lack of T3 availability, and what is the social cost of that, put against the cost of T3? In addition, what is the social cost if someone has to forego employment to look after such a patient? This study shows the inability to look at the wider picture.

[Mollyfan]

sadly all drugs are assessed on this kind of basis, including cancer drugs. They work out the cost per life saved or the cost/ benefit ratio. I would say that it is difficult to assess benefit in a consistent way, especially when they simply don’t ask the patient what the benefit to them is!