Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011–2020
Open accessAbstract
Introduction: Recent prescribing policies in England and Wales have imposed significant restrictions on liothyronine prescribing in general practice driven by the prohibitive costs and uncertain benefits of liothyronine in the management of hypothyroidism. However, the impact of these policies on liothyronine usage and costs is still unclear. Methods: Data were downloaded from the NHS monthly General Practice Prescribing Data in England and from the Comparative Analysis System for Prescribing Audit (CASPA) in Wales for 2011–2020. Trends over the period in amount and costs of levothyroxine and liothyronine prescribing were analysed. Results: The total medication costs per year for England Wales for hypothyroidism rose from £60.8 million to £129.8 million in 2015–16 and have since reduced to £88.4 million. Levothyroxine prescriptions have been growing above the population growth rate at 0.7%/annum in England and 1.1% in Wales. The costs/patient/year for liothyronine rose from £550 to £3000 in 2015–16 and has since fallen to £2500. Use of liothyronine as a percentage of levothyroxine started to fall in 2015–16 at 7%/annum in England and 3% in Wales. Nevertheless, 0.5% of levothyroxine‐treated patients continue to receive liothyronine. All Clinical Commission Groups (CCGs) in England continue to have at least one liothyronine prescribing practice and 48.5% of English general practices prescribed liothyronine in 2019–20. Conclusion: In spite of strenuous attempts to limit prescribing of liothyronine in general practice, a significant number of patients continue to receive this therapy. The price differential of liothyronine vs levothyroxine should be examined again in light of the continuing use of liothyronine.
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Recent surveys of the UK population have revealed significant variability in practice reflecting differences in local guidance, access to liothyronine across health authorities, and interpretations of existing guidelines.
“Recent surveys of the UK population have revealed significant variability in practice reflecting differences in local guidance, access to liothyronine across health authorities, and interpretations of existing guidelines. 60,61”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [60]
Section 3.5 reports significant variation in liothyronine prescribing across English clinical commissioning groups, and the Discussion reports a difference between England and Wales. The paper analyzes prescribing data rather than surveys of the UK population; it does not establish that differences in local guidance, access, or interpretations of guidelines caused the variation. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe high costs of liothyronine in the UK has undoubtedly contributed to this variation.
“The high costs of liothyronine in the UK has undoubtedly contributed to this variation.186”
From Hypothyroidism (2024) · cites this paper as [186]
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Liothyronine cost and prescriptions in England
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Self-citationNatural desiccated thyroid for the treatment of hypothyroidism?
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Self-citation
- Authors
- Stedman, M., Taylor, P., Premawardhana, L., Okosieme, O., Dayan, C., & Heald, A. H.
- Affiliations
- Res Consortium Andover UK
- Cardiff University (GB)
- Manchester Academic Health Science Centre (GB)
- Corresponding author
- Heald, Adrian H.
- ORCID
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2021-03-21
- Volume
- 94
- Issue
- 6
- Pages
- 980-989
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W3118285466
- Cited by
- 16
- References
- 13
- Citations by year
- 2025: 4 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 4
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Endocrinology (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by-nc)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- ChesterRep (University of Chester) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- liothyronine, levothyroxine, hypothyroidism, prescribing trends, drug costs, prescribing restrictions, primary care prescribing, price differentials, thyroid hormone replacement, England and Wales
- MeSH terms
- England, Humans, Hypothyroidism, Practice Patterns, Physicians', Thyroxine, Triiodothyronine, Wales
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