Abstract：
BACKGROUND: Primary hypothyroidism affects about 3% of the general population in Europe. In most cases people with hypothyroidism are treated with levothyroxine. In the context of the 2023 British Thyroid Association guidance and the 2020 Competitions and Marketing Authority (CMA) ruling, we examined prescribing data for levothyroxine, Natural desiccated thyroid (NDT) and liothyronine by dose, regarding changes over the years 2016-2022.
METHODS: Monthly primary care prescribing data for each British National Formulary code were analysed for levothyroxine, liothyronine and NDT.
METHODS: The rolling 12-month total/average of cost or prescribing volume was used to identify the moment of change. Results included number of prescriptions, the actual costs, and the cost/prescription/mcg of drug.
RESULTS: Liothyronine: In 2016 94% of the total 74,500 prescriptions were of the 20 mcg dose. In 2020 the percentage prescribed in the 5 mcg and 10 mcg doses started to increase so that by 2022 each reached nearly 27% of total liothyronine prescribing. The average cost/prescription in 2016 of 20 mcg was £404/prescription and this fell by 80% to £101 in 2022; while the 10 mcg cost of £348/prescription fell by only 35% to £255 and the 5 mcg cost of £355/prescription fell by 38% to £242/prescription. The total prescriptions of liothyronine in 2016 were 74,605, falling by 30% up to 2019 when they started to grow again - most recently at 60,990-15% lower than the 2016 figure, with the result that total costs fell by 70% to £9 m/year.
CONCLUSIONS: Liothyronine costs fell after the CMA ruling but remain orders of magnitude higher than for levothyroxine. The remaining 0.2% of patients with liothyronine treated hypothyroidism are still absorbing 16% of medication costs. The lower liothyronine 5cmg and 10 mcg doses as recommended by BTA are 240% the costs of the 20 mcg dose. Thus, following latest BTA guidance which recommends the lower liothyronine doses still incurs substantial additional costs vs the prescribing liothyronine in the no longer recommended treatment regime. High drug price continues to impact clinical decisions, potentially limiting liothyronine therapy availability to a considerable number of patients who could benefit from this treatment.
METHODS: Monthly primary care prescribing data for each British National Formulary code were analysed for levothyroxine, liothyronine and NDT.
METHODS: The rolling 12-month total/average of cost or prescribing volume was used to identify the moment of change. Results included number of prescriptions, the actual costs, and the cost/prescription/mcg of drug.
RESULTS: Liothyronine: In 2016 94% of the total 74,500 prescriptions were of the 20 mcg dose. In 2020 the percentage prescribed in the 5 mcg and 10 mcg doses started to increase so that by 2022 each reached nearly 27% of total liothyronine prescribing. The average cost/prescription in 2016 of 20 mcg was £404/prescription and this fell by 80% to £101 in 2022; while the 10 mcg cost of £348/prescription fell by only 35% to £255 and the 5 mcg cost of £355/prescription fell by 38% to £242/prescription. The total prescriptions of liothyronine in 2016 were 74,605, falling by 30% up to 2019 when they started to grow again - most recently at 60,990-15% lower than the 2016 figure, with the result that total costs fell by 70% to £9 m/year.
CONCLUSIONS: Liothyronine costs fell after the CMA ruling but remain orders of magnitude higher than for levothyroxine. The remaining 0.2% of patients with liothyronine treated hypothyroidism are still absorbing 16% of medication costs. The lower liothyronine 5cmg and 10 mcg doses as recommended by BTA are 240% the costs of the 20 mcg dose. Thus, following latest BTA guidance which recommends the lower liothyronine doses still incurs substantial additional costs vs the prescribing liothyronine in the no longer recommended treatment regime. High drug price continues to impact clinical decisions, potentially limiting liothyronine therapy availability to a considerable number of patients who could benefit from this treatment.
摘要：
背景：原发性甲状腺功能减退症影响欧洲约3％的普通人群。在大多数情况下，甲状腺功能减退症患者接受左甲状腺素治疗。在2023年英国甲状腺协会指南和2020年竞争和营销管理局（CMA）裁决的背景下，我们检查了左甲状腺素的处方数据，自然干燥甲状腺（NDT）和甲状腺氨酸的剂量，关于2016-2022年的变化。
方法：分析了每个英国国家处方标准的每月初级保健处方数据的左旋甲状腺素，甲状腺氨酸和无损检测。
方法：使用成本或处方量的滚动12个月总/平均值来确定变化时刻。结果包括处方数量，实际成本，以及药物的成本/处方/mcg。
结果：Liothyronine：2016年，总共74,500张处方中有94％是20mcg剂量。到2020年，5mcg和10mcg剂量的处方百分比开始增加，到2022年，每种剂量都达到了总剂量的近27%。2016年20mcg的平均成本/处方为404英镑/处方，2022年下降了80％至101英镑;而10mcg的成本为348英镑/处方仅下降了35％，至255英镑，5mcg的成本为355英镑/处方下降了38％，至242英镑/处方。2016年的Liothyronine总处方为74,605，下降了30％，直到2019年开始再次增长-最近一次比2016年的数字低60,990-15％，结果，总成本下降了70%，达到900万英镑/年。
结论：在CMA裁决后，Liothyronine的成本下降，但仍比左甲状腺素高几个数量级。剩余的0.2％接受甲状腺功能减退症治疗的患者仍吸收16％的药物费用。BTA推荐的较低的甲状腺氨酸5cmg和10mcg剂量是20mcg剂量成本的240％。因此，根据最新的BTA指南，建议较低剂量的利塞罗宁仍然会产生大量额外费用，而在不再推荐的治疗方案中使用利塞罗宁。高昂的药价继续影响临床决策，可能限制了相当多可以从这种治疗中受益的患者使用利塞罗宁治疗。
方法：分析了每个英国国家处方标准的每月初级保健处方数据的左旋甲状腺素，甲状腺氨酸和无损检测。
方法：使用成本或处方量的滚动12个月总/平均值来确定变化时刻。结果包括处方数量，实际成本，以及药物的成本/处方/mcg。
结果：Liothyronine：2016年，总共74,500张处方中有94％是20mcg剂量。到2020年，5mcg和10mcg剂量的处方百分比开始增加，到2022年，每种剂量都达到了总剂量的近27%。2016年20mcg的平均成本/处方为404英镑/处方，2022年下降了80％至101英镑;而10mcg的成本为348英镑/处方仅下降了35％，至255英镑，5mcg的成本为355英镑/处方下降了38％，至242英镑/处方。2016年的Liothyronine总处方为74,605，下降了30％，直到2019年开始再次增长-最近一次比2016年的数字低60,990-15％，结果，总成本下降了70%，达到900万英镑/年。
结论：在CMA裁决后，Liothyronine的成本下降，但仍比左甲状腺素高几个数量级。剩余的0.2％接受甲状腺功能减退症治疗的患者仍吸收16％的药物费用。BTA推荐的较低的甲状腺氨酸5cmg和10mcg剂量是20mcg剂量成本的240％。因此，根据最新的BTA指南，建议较低剂量的利塞罗宁仍然会产生大量额外费用，而在不再推荐的治疗方案中使用利塞罗宁。高昂的药价继续影响临床决策，可能限制了相当多可以从这种治疗中受益的患者使用利塞罗宁治疗。
