title: An analysis of product wastage arising from dosing increment granularity in four modern growth hormone administration devices.
abstract: OBJECTIVE
  Human growth hormone (hGH) delivery systems differ in the size of the dose increments that can be set by the patient, affecting proximity to the target (i.e., prescribed) dose which can be attained. We investigated differences in dosing increment granularity in NordiFlex®, FlexPro®, NordiPen® (all multiple dose devices) and MiniQuick® (single dose) delivery systems.
  
  
  METHODS
  A simulation model was developed to project hGH dosing in pediatric patients with growth hormone deficiency, small for gestational age or Turner syndrome, calculating the nearest dose above the target dose administrable by each device in typical EU and US cohorts and projecting the excess dose (hGH wastage) over 1 year of typical use.
  
  
  RESULTS
  The device with the smallest dosing increment (FlexPro 5 mg; 0.025 mg dosing increment) was projected to administer doses < 1% above the target across all indications. MiniQuick (0.2 mg dosing increment) was projected to deliver between 5 and 6% above the target dose. None of the sensitivity analyses changed the conclusion that larger dosing increments result in more hGH wastage.
  
  
  CONCLUSIONS
  In addition to increasing dosing accuracy, finer dosing increments may result in reductions in unnecessary hGH usage, which may in turn result in reductions in the cost of hGH treatment borne by the health-care payer.
authors.affiliation: Ossian Health Economics and Communications GmbH , Bäumleingasse 20, 4051 Basel , Switzerland +41 61 271 6214 ; pollock@ossianconsulting.com.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Pollock
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Kappelgaard
authors.forename: Lisa
authors.initials: L
authors.lastname: Seitz
mesh_terms: D003198:Computer Simulation; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D007267:Injections / Q000295:instrumentation*; D008506:Medical Waste; D014481:United States
chemical_list: D008506:Medical Waste; D019382:Human Growth Hormone
keywords: computer simulation; drug delivery systems; growth hormone; injections; subcutaneous