title: Provincial disparities of growth hormone coverage for young adult survivors of paediatric brain tumours across Canada.
abstract: BACKGROUND
  Young adult survivors of paediatric brain tumours (PBTs) who have been treated with radiation therapy will likely be severely growth hormone-deficient when retested at the achievement of final height. Growth hormone replacement therapy (GHRT) is administered to treat growth hormone deficiency (GHD). Public drug coverage for GHRT falls under the responsibility of provincial governments across Canada. This study sought to determine the extent of public drug coverage and cost in each Canadian province for GHRT to treat GHD during adulthood for young adult survivors of PBTs.
  
  
  METHODS
  Data were collected from provincial government resources and drug formularies from 2012-2013 on the extent of coverage for GHRT based on a clinical case scenario representative of a young adult survivor of a PBT with childhood-onset radiation-induced GHD, the ingredient cost for GHRT and the applicable provincial public drug plan cost-sharing policies. A model was then created to simulate out-of-pocket costs incurred by a young adult male and a young adult female survivor of a PBT for one year of GHRT in each province with applicable cost-sharing arrangements and levels of low annual individual total income that best represent the majority of young adult survivors of PBTs. Out-of-pocket costs were expressed as a percentage of annual income. Comparisons were made between provinces descriptively, and variation among provinces was summarized statistically.
  
  
  RESULTS
  Alberta, Manitoba, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador provide coverage for GHD during adulthood on a case-by-case basis, while British Columbia, Saskatchewan, Nova Scotia and Prince Edward Island provide no coverage. The percentage of annual income to fund GHRT across the provinces without public coverage ranged from 14.4% to 25.5% for males and 21.5% to 38.3% for females, and with public coverage was 0.0% to 4.1% for males and 0.0% to 5.0% for females.
  
  
  CONCLUSIONS
  There are considerable out-of-pocket costs and variation in coverage provided by provincial public drug plans to fund GHRT for young adult survivors of PBTs with GHD. The implementation of a national drug formulary could potentially prevent undue financial hardship and remove disparities resulting from variations in provincial drug plans.
authors.affiliation: Project Manager, Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC.
authors.forename: Haroon
authors.initials: H
authors.lastname: Hasan
authors.affiliation: Post-Doctoral Fellow, School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Fuchsia
authors.initials: F
authors.lastname: Howard
authors.affiliation: Professor & Associate Director, Centre of Health Services and Policy Research, University of British Columbia, Vancouver, BC.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Morgan
authors.affiliation: Paediatric Endocrinologist & Clinical Professor, University of British Columbia, Clinical Investigator, Child Family Research Institute, Endocrinology & Diabetes Unit, BC Children's Hospital, Vancouver, BC.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Metzger
authors.affiliation: Radiation Oncology Resident, Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Lo
authors.affiliation: Radiation Oncologist, Department of Radiation Oncology, BC Cancer Agency, Clinical Associate Professor, University of British Columbia, Vancouver, BC.
authors.forename: Karen
authors.initials: K
authors.lastname: Goddard
authors.affiliation: Adult Endocrinologist, Division of Endocrinology, St. Paul's Hospital and Clinical Associate Professor, University of British Columbia, Vancouver, BC.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Gill
authors.affiliation: Adult Endocrinologist, Division of Endocrinology, St. Paul's Hospital and Clinical Assistant Professor, University of British Columbia, Vancouver, BC.
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy; D002170:Canada; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005382:Financing, Personal / Q000191:economics; D054625:Healthcare Disparities; D019382:Human Growth Hormone / Q000172:deficiency / Q000191:economics* / Q000528:radiation effects; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects; D017741:Survivors
chemical_list: D019382:Human Growth Hormone
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