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


==Cost-Effectiveness of Therapy==
==Cost-Effectiveness of Therapy==
* There are limited data about cost-effectiveness of therapy in delayed [[puberty]].
* The main part of the economic burden of delayed [[puberty]] is because of its various and specific [[blood tests]], such as [[hormone]] assay.
* The main treatment for the patients with [[short stature]] is [[Growth hormone|growth hormone (GH)]].
=== Delayed puberty diagnostic laboratory tests ===
* The brief definition of various [[hormone]] laboratory tests that maybe used for diagnosis of delayed [[puberty]] is presented here.<ref name="pmid10414639">{{cite journal |vauthors=Blondell RD, Foster MB, Dave KC |title=Disorders of puberty |journal=Am Fam Physician |volume=60 |issue=1 |pages=209–18, 223–4 |year=1999 |pmid=10414639 |doi= |url=}}</ref>
{| class="wikitable"
!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 inches the children have gained (cost per inches) are presented here.<ref name="LeeDavis2006">{{cite journal|last1=Lee|first1=Joyce M.|last2=Davis|first2=Matthew M.|last3=Clark|first3=Sarah J.|last4=Hofer|first4=Timothy P.|last5=Kemper|first5=Alex R.|title=Estimated Cost-effectiveness of Growth Hormone Therapy for Idiopathic Short Stature|journal=Archives of Pediatrics & Adolescent Medicine|volume=160|issue=3|year=2006|pages=263|issn=1072-4710|doi=10.1001/archpedi.160.3.263}}</ref>
{| class="wikitable"
!Group
!Variable
!Cost per child
(USD)
!Growth per child
(in.)
!Cost per inches
(USD)
|-
| rowspan="2" |Efficacy
|Lower (1.8 in)
|$ 99,959
|1.2
|$ 81,875
|-
|Higher (3.9 in)
|$ 99,959
|2.6
|$ 38,783
|-
| rowspan="2" |Age at initiation
|8-13 years of age
|$ 81,268
|1.9
|$ 42,792
|-
|12-16 years of age
|$ 126,123
|1.9
|$ 66,411
|-
| rowspan="2" |Discontinuation rate
|0%
|$ 137,779
|2.6
|$ 53,531
|-
|40%
|$ 87,352
|1.7
|$ 52,174
|-
| rowspan="3" |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
|-
| rowspan="2" |Treatment duration
|7 years (age 8-15 years old)
|$ 122,513
|2.5
|$ 49,396
|-
|10 years (age 5-15 years old)
|$ 145,550
|3.2
|$ 45,156
|}
* General economic burden, consist of [[pharmacy]] costs, [[physician]] costs, and [[laboratory]] and [[Radiological|radiologic]] tests costs were measured as following:
** [[GH]] cost per milligram, $52
** Cost of [[physician]] visit, $58
** [[Bone age|Bone-age]] [[Radiography|radiograph]], $17
** Free [[thyroxine]] and [[thyrotropin]] measurement, $74
** [[Insulin-like growth factor 1|Insulin-like growth factor I]] determination, $27.<ref name="LeeDavis2006" />


==References==
==References==

Revision as of 15:23, 14 September 2017

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

Overview

There are limited data about cost-effectiveness of therapy in delayed puberty. The main part of the economic burden of delayed puberty is because of its various 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

Delayed puberty diagnostic laboratory tests

  • The brief definition of various hormone laboratory tests that maybe 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 inches 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
Higher (3.9 in) $ 99,959 2.6 $ 38,783
Age at initiation 8-13 years of age $ 81,268 1.9 $ 42,792
12-16 years of age $ 126,123 1.9 $ 66,411
Discontinuation rate 0% $ 137,779 2.6 $ 53,531
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
10 years (age 5-15 years old) $ 145,550 3.2 $ 45,156

References

  1. ↑ Blondell RD, Foster MB, Dave KC (1999). "Disorders of puberty". Am Fam Physician. 60 (1): 209–18, 223–4. PMID 10414639.
  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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