title: Three-year experience with access to nationally funded growth hormone (GH) replacement for GH-deficient adults.
abstract: OBJECTIVE
  Treatment of growth hormone (GH)-deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported.
  
  
  METHODS
  Retrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists.
  
  
  METHODS
  Applications for 201 patients were assessed and 191 approved for funded treatment over the initial 3 years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary.
  
  
  RESULTS
  After an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA(®) instrument (baseline (95%CI) 19 (18-21), 9 months 6 (5-7.5)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2.8 ± 0.6 cm. The mean maintenance GH dose after 9 months of treatment was 0.39 mg/day. After 3 years, 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9 months of treatment.
  
  
  CONCLUSIONS
  Carefully designed access to nationally funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.
authors.affiliation: Department of Endocrinology, Auckland Hospital and Greenlane Clinical Centre, Auckland, New Zealand.
authors.forename: I M
authors.initials: IM
authors.lastname: Holdaway
authors.affiliation: Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Hunt
authors.affiliation: Department of Endocrinology, Dunedin Hospital, Dunedin, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Manning
authors.affiliation: Liggins Institute, Auckland University School of Medicine, Auckland, New Zealand.
authors.forename: W
authors.initials: W
authors.lastname: Cutfield
authors.affiliation: Department of Medicine, University of Auckland School of Medicine, Auckland, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: Gamble
authors.affiliation: Pharmaceutical Management Agency, Wellington, New Zealand.
authors.forename: N
authors.initials: N
authors.lastname: Ninow
authors.affiliation: Pharmaceutical Management Agency, Wellington, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Staples-Moon
authors.affiliation: Pharmaceutical Management Agency, Wellington, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Moodie
authors.affiliation: Pharmaceutical Management Agency, Wellington, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: Metcalfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016527:Drug Costs; D004608:Eligibility Determination; D005260:Female; D005380:Financing, Government; D020249:Hormone Replacement Therapy / Q000191:economics / Q000379:methods*; D019382:Human Growth Hormone / Q000172:deficiency / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I