There are traditionally two major methods of treating autoimmune biochemical hyperthyroidism (Grave's disease) with anti-thyroid medication employed by Endocrinologist's in the UK today. The first is dose titration and the second is block and replace, each treatment regime has it's own advantages and disadvantages and there is sometimes controversy over which is the best approach. A Cochrane review in 2005, undertook a systematic evaluation of all the good quality trials to date which had compared the two types of treatment including the duration of therapy. The conclusion was that there were no significant differences in success rates or outcomes between the two. What was not included in this evaluation however was the economic argument. That is, the actual cost of the two approaches in terms of; average medication use, number of thyroid function tests and the number of follow up appointments required. For example; What is the cost 1218 months of Carbimazole? 547 days×£0.336=£184.1 What is the cost of 6 months block and replace? Carbimazole £61.43+Levothyroxine £6.45=£67.88 12 months of block and replace? Carbimazole £122.85+Levothyroxine £12.91=£135.75 Our full analysis demonstrates that 6 months treatment with block and replace therapy is cheaper than other regimes overall and requires fewer blood tests, fewer out-patient appointments and is no less efficacious than the alternatives. This present analysis therefore aims to contribute an economic dimension to determine the best practice approach to treating Grave's disease in the current financial climate.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.