Background: Thyroid hormone replacement is one of the most commonly prescribed and cheapest treatments for a chronic disease. There have been recent changes in community prescribing policies in many areas of the UK that have changed patient access to necessary medications.
Aim: To provide a picture of thyroid hormone usage in the UK and to survey patient opinion about current community prescribing policies for levothyroxine.
Methods: Data on community prescriptions for thyroid hormones in England between 1998 and 2007, provided by the Department of Health, were collated and analysed. A survey of UK members of the British Thyroid Foundation who were taking levothyroxine was carried out.
Results: The amount of prescribed thyroid hormones used in England has more than doubled, from 7 to 18 million prescriptions, over the last 10 years. The mode duration of prescriptions has reduced from 60 to 45 days, over the same time. The professional dispensing fee to the pharmacist is £0.90 per prescription, which is close to the £1.12 cost for 28 levothyroxine tablets. Two thousand five hundred and fifty-one responses to the patient survey were received (42% of the 6083 dispatched). Thirty-eight percent of levothyroxine users reported receiving prescriptions of 28 days duration. Seventeen percent had gone without levothyroxine owing to difficulties getting their medication. Fifty-nine percent of respondents reported being dissatisfied with 28-day prescribing. The major reasons stated for dissatisfaction were inconvenience, interference with full-time working, and having a monthly reminder of having a health problem.
Conclusion: Amongst users of levothyroxine there is widespread patient dissatisfaction with 28-day prescription duration. Analysis of the full costs of 28-day dispensing balanced against the potential savings of reduced wastage of thyroid medications suggests that this is unlikely to be a fiscally effective policy.