The association between adherence to levothyroxine and economic and clinical outcomes in patients with hypothyroidism in the US

Hepp, Zsolt; Lage, Maureen J.; Espaillat, Ramon; Gossain, Ved V.

doi:10.1080/13696998.2018.1484749

Cited by 28 publications

(25 citation statements)

References 44 publications

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“…The search for the new oral levothyroxine formulations is caused mainly by nonadherence and malabsorption of tablet formulations. Nonadherence concerns up to 17-40% of hypothyroid patients and increases over time; however, the reported rates differ in whether healthcare data or self-reports are analysed [55,56]. Although the reasons of nonadherence can be various and this problem is generally observed in 50% of all chronically ill patients, in the case of tablet levothyroxine the necessity of its ingestion in the fasting state 30-60 minutes before the breakfast or three hours after the last meal delivers an additional obstacle.…”

Section: Discussionmentioning

confidence: 99%

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Gietka-Czernel

Hubalewska‐Dydejczyk

Kos–Kudła

et al. 2020

Endokrynologia Polska

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Section: Discussionmentioning

confidence: 99%

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Gietka-Czernel

Hubalewska‐Dydejczyk

Kos–Kudła

et al. 2020

Endokrynologia Polska

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“…In addition, the likelihood of sub-optimal adherence to LT4 appears to vary according to the preparation prescribed [75,77]. Sub-optimal adherence to LT4 therapy has important negative consequences for long-term outcomes: better adherence to LT4 therapy has been associated with reduced need for healthcare resources and enhanced long-term health trajectory in a large database analysis [78]. A TSH test conducted after a period of supervised administration of LT4 can help to identify patients whose chronically elevated TSH is due to missed doses of LT4 [79].…”

Section: Is the Patient Taking Levothyroxine As Directed?mentioning

confidence: 99%

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Razvi

Mrabeti²,

Luster

2020

Endocrine Connections

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The current standard of care for hypothyroidism is levothyroxine (LT4) monotherapy to reduce levels of thyrotropin (thyroid stimulating hormone, TSH) to within its reference range and amelioration of any symptoms. A substantial minority continue to report hypothyroid-like symptoms despite optimised TSH, however. These symptoms are not specific to thyroid dysfunction and are frequent among the euthyroid population, creating a therapeutic dilemma for the treating clinician as well as the patient. We present a concise, narrative review of the clinical research and evidence-based guidance on the management of this challenging population. The clinician may endeavour to ensure that the serum TSH is within the target range. However, the symptomatic patient may turn to alternative non-evidence-based therapies in the hope of obtaining relief. Accordingly, it is important for the clinician to check for conditions unrelated to the thyroid that could account for the ongoing symptoms such as other autoimmune conditions, anaemia or mental health disorders. Systematic and thorough investigation of the potential causes of persistent symptoms while receiving LT4 therapy will resolve the problem for most patients. There may be some patients that may benefit from additional treatment with liothyronine (LT3), although it is unclear as yet as to which patient group may benefit the most from combined LT4 + LT3 therapy. In the future, personalised treatment with LT4 + LT3 may be of benefit for some patients with persistent symptoms of hypothyroidism such as those with polymorphisms in the deiodinase enzyme 2 (DIO2). For now, this remains a subject for research.

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“…Adjudicated claims with primary or secondary diagnoses of endometriosis were used to calculate endometriosis-related HCRU and costs [24]. Endometriosis-related pharmacy fills and costs were further specified for drugs primarily used in endometriosis management (danazol, goserelin, leuprolide, nafarelin, estrogen/progestin oral contraceptives).…”

Section: Outcome Measuresmentioning

confidence: 99%

Healthcare Resource Use and Costs Associated with Opioid Initiation Among Patients with Newly Diagnosed Endometriosis with Commercial Insurance in the USA

Estes

Soliman

Zivkovic³

et al. 2020

Adv Ther

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Introduction: To compare all-cause and endometriosis-related healthcare resource utilization (HCRU) and healthcare costs by service categories (outpatient, inpatient, emergency room [ER], pharmacy) among patients with newly diagnosed endometriosis using opioids compared to patients with endometriosis not using opioids. Methods: A retrospective analysis of IBMÒ MarketScanÒ Commercial Claims data from 2009 to 2018 was performed for women aged 18-49 with newly diagnosed endometriosis (International Classification of Diseases (ICD)-9 code 617.xx; ICD-10 code N80.xx) over 24 months follow-up. Patients were stratified on the basis of opioid use within 12 months post first endometriosis diagnosis date. Patients with opioid use were 1:1 matched to patients without opioid use using propensity score matching. Results: A total of 85,329 female patients with a new endometriosis diagnosis were identified and 48,470 patients (24,235 opioid and 24,235 non-opioid users) remained after inclusion-exclusion criteria and matching. Opioid patients had an estimated mean 30.33 outpatient visits, 29.59 pharmacy fills, 0.28 inpatient visits, 0.65 ER visits, and total length of stay (LOS) was 1.01 days. Non-opioid patients had an estimated mean 27.94 outpatient visits, 22.06 pharmacy fills, 0.23 inpatient visits, 0.42 ER visits, and total LOS was 0.82 days. On average, opioid patients had significantly greater allcause HCRU compared to non-opioid patients (all p \ 0.0001). Among endometriosis-related healthcare utilization, there were similar ER visits, but lower outpatient visits, inpatient visits, and total LOS and higher pharmacy fills among opioid and non-opioid patients. Estimated mean all-cause costs were higher among opioid ($26,755) vs. non-opioid ($19,302) users (p \ 0.0001). A similar trend was observed for estimated mean endometriosis-related costs. Conclusion: This analysis observed significantly higher all-cause HCRU and costs for opioid users compared to non-opioid users Digital Features To view digital features for this article go to

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The association between adherence to levothyroxine and economic and clinical outcomes in patients with hypothyroidism in the US

Abstract: 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.

Cited by 28 publications

References 44 publications

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation — Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review

Healthcare Resource Use and Costs Associated with Opioid Initiation Among Patients with Newly Diagnosed Endometriosis with Commercial Insurance in the USA

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