Delayed puberty cost-effectiveness of therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

There are limited data about the cost-effectiveness of therapy in delayed puberty. The main part of the economic burden of delayed puberty is because of various non-specific and specific blood tests, such as hormone assay. The main treatment for the patients with short stature is growth hormone (GH). The potential cost of treating all eligible children with growth hormone (GH) is approximately $40 billion dollars.

Cost-Effectiveness of Therapy

There are limited data about the cost-effectiveness of therapy in delayed puberty.
The main part of the economic burden of delayed puberty is because of various non-specific and specific blood tests, such as hormone assay.
The main treatment for the patients with short stature is growth hormone (GH).

Delayed puberty diagnostic laboratory tests

The brief definition of various hormone laboratory tests that may be used for diagnosis of delayed puberty is presented here.^[1]

Laboratory test	Cost (USD)
Follicle stimulating hormone (FSH)	$ 57
Luteinizing hormone (LH)	$ 57
Estradiol	$ 46
Testosterone	$ 58
Prolactin	$ 48
Human gonadotropic hormone (hCG), beta sub-unit (quantitative)	$ 44
Thyroid function tests (TSH, T4, T3, T3RU)	$ 57
Gonadotropin-releasing hormone (GnRH)	$ 322

Growth hormone therapy

General cost of GH treatment for every child (cost per child), the average height improvement in every child (growth per child), and measured cost of every inch the children have gained (cost per inches) are presented here.^[2]

Group	Variable	Cost per child (USD)	Growth per child (in.)	Cost per inches (USD)
Efficacy	Lower (1.8 in)	$ 99,959	1.2	$ 81,875
Efficacy	Higher (3.9 in)	$ 99,959	2.6	$ 38,783
Age at initiation	8-13 years of age	$ 81,268	1.9	$ 42,792
Age at initiation	12-16 years of age	$ 126,123	1.9	$ 66,411
Discontinuation rate	0%	$ 137,779	2.6	$ 53,531
Discontinuation rate	40%	$ 87,352	1.7	$ 52,174
Dosing	Low-dose (0.24 mg/kg/week)	$ 65,092	1.4	$ 45,700
	Standard dose (0.37 mg/kg/week) for 2 years then High dosage (0.7 mg/kg/week) at puberty for 3 years	$ 155,440	3.1	$ 49,821
	Standard dose (0.37 mg/kg/week) for 1 years then High dosage (0.7 mg/kg/week) at puberty for 4 years	$ 170,866	3.4	$ 50,384
Treatment duration	7 years (age 8-15 years old)	$ 122,513	2.5	$ 49,396
Treatment duration	10 years (age 5-15 years old)	$ 145,550	3.2	$ 45,156

General economic burden, consists of pharmacy costs, physician costs, and laboratory and radiologic tests costs were measured as follows:
- GH cost per milligram, $52
- Cost of physician visit, $58
- Bone-age radiograph, $17
- Free thyroxine and thyrotropin measurement, $74
- Insulin-like growth factor I determination, $27.^[2]

References

↑ Blondell RD, Foster MB, Dave KC (1999). “Disorders of puberty”. Am Fam Physician. 60 (1): 209–18, 223–4. PMID 10414639.
↑ ^2.0 ^2.1 Lee, Joyce M.; Davis, Matthew M.; Clark, Sarah J.; Hofer, Timothy P.; Kemper, Alex R. (2006). “Estimated Cost-effectiveness of Growth Hormone Therapy for Idiopathic Short Stature”. Archives of Pediatrics & Adolescent Medicine. 160 (3): 263. doi:10.1001/archpedi.160.3.263. ISSN 1072-4710.

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[pmid10414639-1] Blondell RD, Foster MB, Dave KC (1999). “Disorders of puberty”. Am Fam Physician. 60 (1): 209–18, 223–4. PMID 10414639.

[LeeDavis2006-2] 2.0 ^2.1 Lee, Joyce M.; Davis, Matthew M.; Clark, Sarah J.; Hofer, Timothy P.; Kemper, Alex R. (2006). “Estimated Cost-effectiveness of Growth Hormone Therapy for Idiopathic Short Stature”. Archives of Pediatrics & Adolescent Medicine. 160 (3): 263. doi:10.1001/archpedi.160.3.263. ISSN 1072-4710.

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