Endocrine Abstracts

Background: CMA showed price paid for liothyronine tablets rose from £15.15 in 2009 to £258.19 in 2017; a £100 million fine against suppliers was made public December 2021. BTA published guidance on use of liothyronine for appropriate patients in May 2023 suggesting daily dose 5-10mg at possible split twice day. This report investigated link between amounts and costs of T3 prescribing for different dose levels over the last 6 years.

Method: Monthly primary care prescribing data for liothyronine, levothyroxine and NDT by dose levels was analysed to examine change from 2016 to 2022. The monthly rolling 12month total/average was used to identify specific moments. Outcomes included number of GP practices issuing prescriptions, number of prescriptions, actual costs, mgT3, and the cost/prescription &/mg T3

Results: Liothyronine prescriptions fell by 30% then in 2020 started to grow reaching 61,000 in 2022 still 18% below 2016. In 2020 % of 5 & 10 mg prescriptions started to rise from 7% to 30%. In 2019 average cost/item started to fall reaching £146/prescription in 2022 37% of the 2016 value, 20mg fell by 75% to £101/prescription (£0.11/mgT3), 10 mg by 27% to £255/prescription (£0.47/mgT3) and 5mg by 32% to £241 (£0.64/mgT3). Total annual cost fell 70% to £9m/year. % of practices prescribing liothyronine fell from 49% of total to 36%. Levothyroxine cost/prescription fell 47% from £2.94 to £1.57, as total increased by 9% to 30.7 million so total costs fell 42% to £52m/year. NDT costs/prescriptions increased from £207 to £440, total reduced by 44% to 2384 prescriptions, so total costs increased to £1 million.

Conclusion: Liothyronine cost/prescription/mgT3 have fallen significantly but remain 10 times higher than 2009 levels. Lower dose Liothyronine are more than double the costs of higher dose, so significant cost pressure remains against compliance with latest BTA guidance.