Trends in thyroid hormone prescribing and consumption in the UK

Abstract

Background: Thyroid hormone replacement is one of the most commonly prescribed and cost effective treatments for a chronic disease. There have been recent changes in community prescribing policies in many areas of the UK that have changed patient access to necessary medications. This study aimed to provide a picture of thyroid hormone usage in the UK and to survey patient opinion about current community prescribing policies for levothyroxine.

Methods: Data on community prescriptions for thyroid hormones in England between 1998 and 2007, provided by the Department of Health, were collated and analysed. A survey of UK members of a patient support organisation (the British Thyroid Foundation) who were taking levothyroxine was carried out.

Results: The amount of prescribed thyroid hormones used in England has more than doubled, from 7 to almost 19 million prescriptions, over the last 10 years. The duration of prescriptions has reduced from 60 to 45 days, on average over the same time. Two thousand five hundred and fifty one responses to the patient survey were received. Thirty eight percent of levothyroxine users reported receiving prescriptions of 28 days' duration. 59% of respondents reported being dissatisfied with 28-day prescribing.

Conclusion: Amongst users of levothyroxine, there is widespread patient dissatisfaction with 28-day prescription duration. Analysis of the full costs of 28-day dispensing balanced against the potential savings of reduced wastage of thyroid medications, suggests that this is unlikely to be an economically effective public health policy.

Figure 1

Quantity and cost of thyroid hormone replacement in England. Panel A – The number of prescription items dispensed in thousands for all thyroid hormone replacement therapies (levothyroxine, liothyronine and Armour thyroid) from 1998 to 2007 (PCA data). Panel B – Net ingredient cost of thyroid hormone replacement therapy in England from 1998 to 2007.

Figure 2

Length of levothyroxine prescriptions. Panel A – Temporal trend in the mean prescription content, for levothyroxine 100 μg tablets, from 1998 to 2007 in England (PCA data). Panel B – Length of prescription issued to patients responding to BTF survey (n = 2551 responses).

Figure 3

Patient opinion about 28-day prescribing. Data taken from BTF survey responses. Panel A – Patient satisfaction with the 28 day prescribing policy. Panel B – Most frequent responses of reasons for dissatisfaction with the 28 day prescribing.