title: Effects of financial support on treatment of adolescents with growth hormone deficiency: a retrospective study in Japan.
abstract: Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation.
  
  
  
  A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects.
  
  
  
  Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 % vs. 52.0 %, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 % confidence interval [CI]: 1.86-8.78) in boys and 1.72 (95 % CI: 0.80-3.70) in girls, after adjusting for demographic characteristics and clinical factors.
  
  
  
  Financial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.
authors: Department of Environmental Health Sciences, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita-shi, Akita, 010-8543, Japan.
authors: Eri
authors: E
authors: Maeda
authors: Division of Health Services Research, Center for Cancer Control and Information Services, The National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. thigashi@ncc.go.jp.|GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. thigashi@ncc.go.jp.
authors: Takahiro
authors: T
authors: Higashi
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Tomonobu
authors: T
authors: Hasegawa
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Susumu
authors: S
authors: Yokoya
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Takahiro
authors: T
authors: Mochizuki
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Tomohiro
authors: T
authors: Ishii
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Junko
authors: J
authors: Ito
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Susumu
authors: S
authors: Kanzaki
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Akira
authors: A
authors: Shimatsu
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Koji
authors: K
authors: Takano
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Toshihiro
authors: T
authors: Tajima
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Hiroyuki
authors: H
authors: Tanaka
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Yusuke
authors: Y
authors: Tanahashi
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Akira
authors: A
authors: Teramoto
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Toshiro
authors: T
authors: Nagai
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Kunihiko
authors: K
authors: Hanew
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Reiko
authors: R
authors: Horikawa
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Toru
authors: T
authors: Yorifuji
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Naohiro
authors: N
authors: Wada
authors: GH Treatment Study Committee, The Foundation for Growth Science, 5-1-16 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
authors: Toshiaki
authors: T
authors: Tanaka
mesh_terms: D000293:Adolescent; D001827:Body Height; D002648:Child; D005260:Female; D005378:Financial Support; D006130:Growth Disorders / Q000188:drug therapy / Q000191:economics*; D019382:Human Growth Hormone / Q000172:deficiency / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies
chemical_list: D019382:Human Growth Hormone
keywords: Children with special health care needs; Health insurance; Japan; Public funding