Liothyronine (LT3) prescribing in england - are cost constraints inhibiting guideline implementation?

Adrian Heald; Lakdasa Premawardhana; John Warner-Levy; Peter Taylor; Nadia Chaudhury; Onyebuchi Okosieme; Mike Stedman; Colin Dayan

doi:10.1530/endoabs.99.EP361

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Endocrine Abstracts (2024) 99 EP361 | DOI: 10.1530/endoabs.99.EP361

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Liothyronine (LT3) prescribing in england – are cost constraints inhibiting guideline implementation?

Adrian Heald ¹ , Lakdasa Premawardhana ² , John Warner-Levy ¹ , Peter Taylor ² , Nadia Chaudhury ³ , Onyebuchi Okosieme ² , Mike Stedman ⁴ & Colin Dayan ²

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¹Salford Royal Hospital, Salford, Department of Endocrinology and Diabetes, Salford, United Kingdom; ²Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, Wales, Cardiff, United Kingdom; ³University Hospitals Coventry and Warwickshire, Department of Endocrinology and Diabetes, Coventry, United Kingdom; ⁴Res Consortium, Andover, England, Andover, United Kingdom

Introduction: Primary hypothyroidism affects about 3% of the general population in Europe. In most cases, people are treated with Levothyroxine. In relation to the recent British Thyroid Association guidance and the 2020 Competitions and Marketing Authority (CMA) ruling, we examined prescribing data for levothyroxine, NDT and liothyronine by dose, regarding changes from 2016 to 2022.

Design: Monthly primary care prescribing data for each British National Formulary (BNF) code (England Monthly GP Practice thyroid replacement prescribing data. Accessed 17 July 2023). was analysed for Levothyroxine, Liothyronine and NDT

Patient and Measurements: The rolling 12-month total/average was used to identify the moment of change. Results included the number of prescriptions, the actual costs, and the cost/prescription/ mg.

>Results: Liothyronine: In 2016 94% of the total 74, 500 prescriptions were in 1 mg dose. In 2020 the % in 1 mg and 1 mg doses started to increase so that in 2022 each reached 27% of total liothyronine. The average Cost/prescription in 2016 of 1 mg was £404/prescription and fell by 80% to £101 in 2022; while the 1 mg cost £348/prescription fell much less by 35% to £255 and 1 mg £355/prescription fell much less by 38% to £242/prescription. Total prescriptions 74, 605 issued in 2016 fell by 30% until 2019 and then started to grow again at 60, 990 15% lower, so total costs have fallen by 70% to £9m/year.

Table 1: Change in the cost between 2016 to 2022 - for LT4, by tablet dose for LT3 and NDT
Drug	Cost per prescription (% change vs 2016)		Total prescriptions (% change vs 2016)		Total cost/year (% change vs 2016)
	2016	2022	2016	2022	2016	2022
LT4	£2.74	£1.47 (- 48%)	30.8 million	33.4million (8%)	£90, 504, 057	£52, 439, 700 (-42%)
Total LT3 20 mg 10 mg 5 mg**	£404 £348 £355	£101 (- 75%) £255 (- 27%) £242 (- 32%)	74, 500	60, 999 (- 18%)	£30, 034, 992	£ 9, 029, 544 (- 70%)
NDT	£207	£440 (+113%)	4257	2384 (- 44%)	£885s, 887	£1, 049, 192 (18%)

Conclusions: Liothyronine costs fell after the CMA ruling but remain orders of magnitude higher than levothyroxine so the remaining 0.2% of patients are still absorbing 16% of medication costs. Lower liothyronine doses as recommended by BTA are 240% of the costs of the 1 mg dose, so following the latest BTA guidance incurs substantial additional costs. High drug price continues to impact clinical decisions limiting therapy availability to a considerable number of patients.