Issues related to recombinant human growth hormone utilization and optimization in a health plan setting

Healthcare expenditures in the United States are high and continue to increase; as a result, providers and managed care organizations have to evaluate the impact of specialty drugs such as recombinant human growth hormone (rhGH) therapy. As the number of approved indications for rhGH therapy has increased, so too have questions about the appropriate allocation of resources for such therapy. This is particularly true for the recent rhGH indications in children with idiopathic short stature and those short for gestational age who fail to attain normal growth percentiles. With a large increase in the number of children eligible for rhGH therapy, questions arise as to whether all eligible children should be treated with rhGH, and what are the appropriate length of treatment and optimal treatment outcomes. These are important questions for managed care organizations who must determine the treatment parameters that produce the best outcomes in children. The primary disease burdens of growth hormone deficiency (GHD) in adults are the changes in body composition and metabolic parameters, and reduced quality of life, all of which are associated with improvements following rhGH therapy. In adults, the primary economic burden of GHD is healthcare-related costs such as increased hospital days and clinic visits.