The association between adherence to levothyroxine and economic and clinical outcomes in patients with hypothyroidism in the US
Open accessAbstract
OBJECTIVE: To evaluate outcomes associated with adherence to levothyroxine (LT4) in the US adult hypothyroidism population. METHODS: We used data from Truven's MarketScan databases from 1 July 2011 through 31 December 2015. Patients aged 18 or older were diagnosed with hypothyroidism (confirmed at least twice) and prescribed LT4. Patients were excluded if they did not have continuous insurance coverage or if they received a diagnosis of thyroid cancer or pregnancy during the study period. Multivariable analyses on a matched cohort of adherent and nonadherent patients examined the relationships among patient outcomes and adherence, defined as the proportion of days covered ≥80%. Outcomes included all-cause and hypothyroidism-related medical costs and resource utilization and comorbid diagnoses measured over the 1 year post-period following the first prescription for LT4. The analyses controlled for patient age, sex, region of residence, type of insurance coverage, diagnosing physician and pre-period general health status as proxied by the Charlson Comorbidity Index. RESULTS: Prior to matching, there were 168,457 patients identified as adherent and 198,443 patients identified as nonadherent. The matched cohort consisted of 318,628 individuals, with equal numbers of adherent and nonadherent patients (n = 159,314). Patients who were adherent used significantly fewer resources and had significantly lower all-cause ($14,136 vs. $14,926; p < .0001) and hypothyroidism-related ($1672 vs. $1709; p < .0001) total costs, although the costs of drugs were higher in the adherent group. Furthermore, adherent patients, compared to nonadherent patients, were significantly less likely to be diagnosed with comorbid Addison's disease, bipolar disorder, chronic kidney disease, depression, migraine, obesity, type 1 diabetes or type 2 diabetes during the follow-up period. CONCLUSIONS: Compared to nonadherence, adherence to LT4 among patients with hypothyroidism was associated with a significant reduction in all-cause and hypothyroidism-related costs and resource utilization as well as significantly lower rates of many comorbid diagnoses.
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About 50% of noncompliant patients had concomitant diseases, including diabetes mellitus, Addison disease, obesity, heart failure, migraine, and mental disorders such as bipolar disorder and depression.
“In addition, ∼50% of noncompliant patients had concomitant diseases, including diabetes mellitus, Addison disease, obesity, heart failure, migraine and mental disorders (bipolar disorder and depression) (125).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [125]
A database study conducted in the United States and a questionnaire study conducted in Italy showed that the low and medium adherence rates were 54.1% and 64.5%, respectively.
“Similarly, a database study conducted in the United States and a questionnaire study conducted in Italy showed that the low and medium adherence rates were 54.1% and 64.5%, respectively (124, 125).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [125]
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- Authors
- Hepp, Z., Lage, M. J., Espaillat, R., & Gossain, V. V.
- Affiliations
- AbbVie (United States) (US)
- HealthMetrics Outcomes Research, Bonita Springs, FL, USA;
- Michigan State University (US)
- Corresponding author
- Lage, Maureen J.
- ORCID
- Lage, Maureen J.
- Venue
- Journal of Medical Economics
- Publisher
- Informa UK Limited
- Published
- 2018-06-22
- Volume
- 21
- Issue
- 9
- Pages
- 912-919
- ISSN
- 1369-6998 (ISSN-L)
- 1941-837X
- OpenAlex
- W2805547899
- Cited by
- 37
- References
- 48
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 7 · 2021: 3 · 2020: 9 · 2019: 4
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Medical Economics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine, medication adherence, hypothyroidism, health care costs, resource utilization (health care), comorbidities, drug costs, matched cohort
- MeSH terms
- Adult, Age Factors, Aged, Health Expenditures, Female, Health Resources, Health Services, Humans, Hypothyroidism, Insurance Claim Review, Male, Middle Aged, Residence Characteristics, Retrospective Studies, Sex Factors, Thyroxine, United States, Comorbidity, Drug Monitoring, Models, Econometric
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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