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Endocrine Abstracts (2021) 77 P118 | DOI: 10.1530/endoabs.77.P118

SFEBES2021 Poster Presentations Thyroid (23 abstracts)

Cost-effectiveness analysis of liothyronine for the management of treatment unresponsive hypothyroidism based on latest evidence

Adrian Heald 1,2 , Konstantinos Skiadas 3 , Deborah Fitzsimmons 3 , Pippa Anderson 3 & Dyfrig Hughes 4


1University of Manchester, Manchester, United Kingdom; 2Salford Royal Hospital, Salford, United Kingdom; 3Swansea Centre for Health Economics, Swansea, United Kingdom; 4Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom


Introduction: Between 5-10% of patients with hypothyroidism treated with levothyroxine (T4) continue to experience profound symptoms, despite achieving free T4/thyroid stimulating hormone concentrations within reference range. Liothyronine is sometimes added to levothyroxine, but its use is controversial due to uncertainties in clinical/cost effectiveness.

Methods: An economic model was developed to estimate the incremental cost per quality-adjusted life year (QALY) gained from the perspective of the NHS in the UK. Health utilities were obtained from a survey of symptomatic hypothyroid patients. EQ-5D-5L profiles were converted to EQ-5D-5L index values (utilities, a preference-weighted measure of patients’ health evaluation) based on the UK EQ-5D-5L/3L cross walk value set. A survey of clinicians provided estimates of healthcare resource use/treatment efficacy.

Results: 37% of people responding to the survey reported severe problems in performing usual activities of everyday living. 22% reported severe anxiety/depression symptoms. Mean utility was 0.53 (the UK population norm for the EQ-5D-3L, for the age category of 45-54 years is 0.85) (SD 0.25), decreasing to 0.80 (0.26) for category 55-64 years. The mean (SD, minimum, maximum) EQ-VAS score was 49.3 (17.2, 5.0, 90.0)(100 indicates optimal health). The model indicated that at £11,881/QALY gained, the incremental cost effectiveness ratio fell below the cost-effectiveness threshold of £20,000/QALY operating in the NHS, and was stable to modelling assumptions. The probability of liothyronine/levothyroxine combination therapy being cost effective at this threshold was 0.56. The estimated value of eliminating the uncertainty surrounding the decision problem (£3.64m per year in UK) significantly exceeds the plausible costs of a clinical trial.

Conclusions: Liothyronine/levothyroxine combination therapy may represent a cost-effective treatment option for patients remaining symptomatic with levothyroxine alone. A definitive clinical trial is necessary to confirm clinical effectiveness, and would be justified given the value of the information gained far exceeds the cost.

Volume 77

Society for Endocrinology BES 2021

Edinburgh, United Kingdom
08 Nov 2021 - 10 Nov 2021

Society for Endocrinology 

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