SHOX mutation as a rare disease: molecular diagnosis and growth hormone treatment supported by the Italian public health system.
Short stature homeobox-containing (SHOX) gene deficiency is acknowledged under the term "dyschondrosteosis", which is included in the family of congenital osteodystrophies. Under current regulations, the cost of the genetic testing and treatment with GH in children with short stature, and SHOX gene deficiency may be reimbursed. Prescription of costs exemption is subject to the identification of the regional centers qualified to diagnose congenital osteodystrophies (RNG060). The centers qualified to diagnose and treat "dyschondrosteosis" have been identified in only a few regions, whereas in other regions centers for the diagnosis and treatment of congenital osteodystrophies have been identified, and in still others, no specific centers have been identified yet. Treatment with GH as indicated by European Medicines Agency (EMEA) for people with short stature and evidence of SHOX gene deficiency is governed by Agenzia Italiana del Farmaco (AIFA) note number 39. The latest version does not provide for the medication to be directly reimbursed by the National Health Service, although it may be prescribed for patients with well-defined auxological characteristics, subject to the prior authorization of the regional commission qualified to monitor the use of the GH. Therefore, a diagnostic/ therapeutic course for patients with short stature with SHOX gene mutation has been proposed. The healthcare course relating to such patients has not been thoroughly defined in terms of implementation and is affected by regional organizational approaches. Implementing specific healthcare courses for such patients may provide a model for treating other patients with short stature and rare diseases with GH.
Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy. info@malattie-rare.org
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D002648:Child; D002675:Child, Preschool; D003677:Deficiency Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D005260:Female; D005820:Genetic Testing / Q000191:economics; D013006:Growth Hormone / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D018398:Homeodomain Proteins / Q000235:genetics*; D006801:Humans; D007558:Italy; D008297:Male; D009154:Mutation / Q000235:genetics*; D011634:Public Health; D035583:Rare Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D000074122:Short Stature Homeobox Protein
D018398:Homeodomain Proteins; C106071:SHOX protein, human; D000074122:Short Stature Homeobox Protein; D013006:Growth Hormone