Changes in nationwide thyroid hormone replacement use during the pandemic: results from the Trends in Drug Utilization During COVID-19 Pandemic in Turkey (PANDUTI-TR) Study

The COVID-19 pandemic and associated measures have had significant impacts on healthcare services, including medication use. We aimed to investigate the nationwide changes in thyroid hormone preparation (THP) utilization before, during, and after the COVID-19 restrictions. We obtained nationwide outpatient THP sales and projected prescribing data for the period between 01.03.2018 and 31.12.2022 from IQVIA Turkey. The average monthly THP consumption, cost, and quarterly projected prescribing levels were analyzed across three periods: "before restrictions" (BfR, 01.03.2018-31.03.2020), "during restrictions" (DuR, 01.04.2020-31.03.2022), and "after restrictions" (AfR, 01.04.2022-31.12.2022). Drug consumption levels were calculated using DID (defined daily dose per 1000 inhabitants per day) parameter. Mean monthly consumption of THPs across BfR, DuR, and AfR was 15.8 ± 3.0, 18.2 ± 4.0 (p > 0.05), and 21.1 ± 3.7 DID (p = 0.001 vs. BfR), respectively. Cost of THPs increased from €2.5 m ± 0.4 m in BfR to €2.8 m ± 0.6 m in DuR (p > 0.05), and €3.5 m ± 0.7 m in AfR (p < 0.001 vs. BfR, p = 0.009 vs. DuR). Projected prescribing levels of these drugs declined from 6.9 ± 0.4 DID in BfR to 6.2 ± 0.5 DID in DuR (p = 0.005), then rose to 7.3 ± 0.03 DID in AfR (p = 0.003 vs. DuR). Ongoing THP users accounted for 89.4% of all projected THP prescriptions and followed the overall trend. Projected prescribing for new users remained stable across three periods (p > 0.05). This study demonstrated that THP utilization showed a modest upward trend since the onset of the COVID-19 pandemic. The increase in consumption following the relaxation of restrictions might be associated with a potentially elevated need for pharmacotherapy, likely due to reduced healthcare access during the extraordinary conditions.