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Drug utilization research

Session: Poster Session A

(212) Regional variations in the use of thyroid stimulating hormone measurements and levothyroxine in Germany: a small area analysis based on claims data

Monday, August 26, 2024
8:00 AM – 6:00 PM CEST
Location: Convention Hall II

    Presenting Author(s)

  • Oliver Scholle, PhD (he/him/his)

    Research Associate
    Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany.
    Bremen, Germany

    • Co-Author(s)

  • AT

    Arulmani Thiyagarajan

    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Germany

  • NK

    Niklas Koenen

    Leibniz Institute for Prevention Research and Epidemiology – BIPS, Germany

  • UH

    Ulrike Haug, PhD

    Prof. Dr. sc. hum.
    Leibniz Institute for Prevention Research and Epidemiology - BIPS
    Bremen, Germany

Background: Drug utilization studies have shown a substantial increase in the prevalence of thyroid-stimulating hormone (TSH) measurement and levothyroxine use in Germany during the past decade, while there was a continuous decline in the prevalence of clinically significant thyroid disorders. This may indicate overuse of thyroid diagnostics and treatment, warranting further investigation. In this regard, analyses of regional variations can provide valuable insights into potential patterns of overuse.

Objectives: To investigate regional variations in the prevalence of TSH measurement and levothyroxine use in Germany in 2019.

Methods: Using the German Pharmacoepidemiological Research Database (GePaRD; claims data covering ~20% of the German population), we conducted cross-sectional analyses to determine the prevalence of at least one TSH measurement or at least one outpatient levothyroxine dispensation in 2019. We included persons aged ≥18 years with continuous insurance coverage in 2019. We calculated age-standardized prevalences per 1,000 persons/year stratified by sex and district of residence (total number of districts: 401). Districts with fewer than 100 eligible persons were excluded.

Results: Overall, we included 6,532,839 men and 7,665,658 women from 397 districts. There were substantial regional variations in the prevalence of TSH measurement (expressed per 1,000 persons/year). It ranged from 127 to 395 in men and from 254 to 497 in women. The same holds true for the prevalence of levothyroxine use. It ranged from 15 to 90 in men and from 82 to 291 in women.

Conclusions: We observed substantial regional variations in the prevalence of TSH measurement and levothyroxine use, which are unlikely due to regional differences in the prevalence of clinically significant thyroid disorders. This supports the hypothesis that there is an overuse of thyroid diagnostics and thyroid medication in Germany.