title: Consequences of brand switches during the course of pediatric growth hormone treatment.
abstract: OBJECTIVE
  To explore the effects of insurance-mandated brand switches during the course of pediatric recombinant human growth hormone (rhGH) treatment on clinical practice.
  
  
  METHODS
  We e-mailed a 9-question, anonymous, Internet-based survey to active members of the Pediatric Endocrine Society. The survey consisted of multiple-choice and yes/no answers. Free-text comments were solicited for further explanation of responses. Quantitative answers were tabulated. Each investigator independently coded the free-text responses; themes based on codes identified by all 3 investigators in a minimum of 5 different respondents' comments were compiled and organized.
  
  
  RESULTS
  Of the 812 active members of the Pediatric Endocrine Society who were e-mailed the survey, 231 responded. Two hundred eight respondents reported switching a patient's regimen from one rhGH product to another, and of these, 50% experienced repeated switches. Switches occurred for each commercially available rhGH brand. Frequent concerns noted by respondents involved dosing errors and treatment lapses from having to learn a new device and impaired adherence related to patient-family frustration and anxiety. Anti-GH antibodies, measured by only 3 endocrinologists when switching a patient's regimen from one brand to another, were negative before and after the product switch. When a patient switched rhGH brands, the most frequently reported time involvement for endocrine office staff was 2 hours for paperwork, 1 hour for device instruction, and 1 hour for "other" (mostly related to telephone reassurance).
  
  
  CONCLUSIONS
  GH brand switches may adversely affect patient care and burden pediatric endocrinology practices.
authors.affiliation: Diagnostic and Research Growth Center, Division of Pediatric Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. grimberg@email.chop.edu
authors.forename: Adda
authors.initials: A
authors.lastname: Grimberg
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Gordon
mesh_terms: D002648:Child; D017046:Cost Savings; D017281:Cost of Illness; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005190:Family; D005569:Formularies as Topic; D019382:Human Growth Hormone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D020407:Internet; D055118:Medication Adherence; D010353:Patient Education as Topic / Q000191:economics; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians' / Q000191:economics; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone