title: An analysis of the clinical and cost effectiveness of growth hormone replacement therapy before and during puberty: should we increase the dose?
abstract: OBJECTIVE
  To investigate the influence of growth hormone (GH) on linear growth before and during puberty in children with GH deficiency.
  
  
  METHODS
  We analysed the relationship between pubertal growth and GH dose in a large dataset of children (n = 236) with GH deficiency using multiple linear regression and multilevel modelling with repeated measures analysis. Additionally, we examined the cost benefit of increasing doses of GH during puberty.
  
  
  RESULTS
  Multilevel modelling revealed a highly significant role for GH dose in the pre-pubertal period (p < 0.001), but a non-significant effect on height gain after pubertal onset (p = 0.32). Important predictors of height gain after puberty onset included gender, age at puberty and number of injections of GH/week. Cost analysis showed that in an average child use of high dose GH, at an extra EUR 5,925 (GBP 4,753/USD 7,538)/year, would produce a height gain of 0.80 cm/year (above baseline growth) pre-pubertally, compared to only 0.20 cm/year post-puberty onset.
  
  
  CONCLUSIONS
  The influence of GH dose on height gain after puberty onset is at best a modest one. Cost analysis shows use of high doses of GH post-puberty onset has significant cost implications without providing a worthwhile gain in adult height for children with GH deficiency.
authors: UCL Institute of Child Health, London, UK.
authors: Sasha R
authors: SR
authors: Howard
authors: Gary E
authors: GE
authors: Butler
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004393:Dwarfism, Pituitary / Q000178:diet therapy / Q000191:economics; D005260:Female; D020249:Hormone Replacement Therapy / Q000191:economics; D019382:Human Growth Hormone / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008954:Models, Biological; D011627:Puberty
chemical_list: D019382:Human Growth Hormone