Category: Professional Posters
Purpose: Levothyroxine injection has recently been affected by intermittent drug shortages leading to clinical initiatives intended to conserve remaining supply. Intravenous levothyroxine has a half-life of three to ten days depending on patient’s thyroid function, with therapeutic effects lasting one to three weeks after discontinuation. Literature suggests patients who cannot receive oral medications can be safely maintained with IV levothyroxine dosed every 5-7 days. The purpose of this study is to assess the impact of levothyroxine injection conservation initiatives including an IV dosing protocol for patients unable to take oral medications.
Methods: An IV levothyroxine dosing protocol was implemented at 8 medical centers across the United States between 2016 and 2017. When the oral route was clinically appropriate, levothyroxine was given orally or through a feeding tube. If oral intake was restricted, IV levothyroxine was administered every one to seven days at 50-75% of the weekly oral dose depending on institution-specific protocol until the patient was able to resume oral therapy. In some instances, IV doses were rounded to the nearest vial size as approved per protocol by the Pharmacy and Therapeutics Committee at each medical center. Exclusion criteria included: new onset hypothyroidism requiring IV levothyroxine therapy, untreated hypothyroidism contributing to current hospitalization, Myxedema coma, signs and symptoms of clinical hypothyroidism, and potential organ donor status requiring continuous infusion levothyroxine per an established organ recovery protocol. IV levothyroxine could be administered at the discretion of the prescriber if any clinical signs or symptoms of hypothyroidism developed. The number of vials and cost per patient hospital day were tracked to assess compliance with the protocol and to calculate the cost savings during the time period between 2016 to 2018.
Results: The median number of levothyroxine vials used decreased from 214 (IQR 229) in 2016 to 66 (IQR 173) in 2018 following implementation of IV dosing protocols although this was not statistically significant (p=0.13). The median cost for IV levothyroxine decreased significantly from $0.38 (IQR $0.34) to $0.13 (IQR $0.21) per patient day (p=0.04) resulting in a combined cost savings of over $104,000 for all hospitals. The acquisition cost during this time period remained consistent. Adverse events were not specifically tracked but provider discretion allowed for use of levothyroxine injection when deemed clinically appropriate.
Conclusion: Implementation of an IV dosing protocol led to reductions in levothyroxine injection utilization and a combined cost savings of over $104,000.