title: Expensive therapies in children: benefit versus cost of combined treatment of recombinant human growth hormone and gonadotropin-releasing hormone analogue in girls with poor height potential.
abstract: OBJECTIVE
  The combination therapy of gonadotropin-releasing hormone analogues (GnRHa) and recombinant human growth hormone (rhGH) has been used to increase growth in children with premature sexual maturation and attenuated growth. The aim of this report was to study the benefit over cost of combined treatment in girls with central precocious puberty (CPP) and poor height prognosis and in girls with idiopathic short stature (ISS) and early puberty. Should this expensive treatment be given to such patients?
  
  
  METHODS
  Two patient groups were included: five girls with central precocious puberty (CPP) who reached final height (FH) at 16.3±1.2 years and eight girls with ISS who reached FH at 14.7±0.8 years. Patients were treated for 3.5±0.6 years.
  
  
  RESULTS
  In both groups, FH improved significantly; in CPP from -1.3 to -0.5 standard deviation score (SDS) (p=0.030) and in ISS from -2.6 to -1.7 SDS (p=0.012). Only girls with CPP reached their target height (-0.5 vs. -0.6 SDS) (p=0.500).
  
  
  CONCLUSIONS
  Both groups had a total height gain of 5 cm. Each centimetre cost about €2700 per patient. This treatment should be considered only in patients with extremely low height prediction and very early pubertal onset.
authors.forename: Meropi
authors.initials: M
authors.lastname: Toumba
authors.forename: Vasilis
authors.initials: V
authors.lastname: Kokotsis
authors.forename: Savvas C
authors.initials: SC
authors.lastname: Savva
authors.forename: Nicos
authors.initials: N
authors.lastname: Skordis
mesh_terms: D000293:Adolescent; D001827:Body Height; D002648:Child; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006130:Growth Disorders / Q000188:drug therapy*; D013006:Growth Hormone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans
chemical_list: D007987:Gonadotropin-Releasing Hormone; D013006:Growth Hormone