Endocrine Abstracts

Objective: To evaluate cost-effectiveness of GH treatment (Genotropin) in adult patients with GHD by comparing health status and costs in patients who received GH treatment with those who did not.

Methods: Direct costs included health care costs related to morbidity (stroke, cardiovascular events) and GH costs. Indirect costs were determined by sick-leave and mortality. A model (Markov-type) was constructed to simulate differences in morbidity and mortality and corresponding costs between treated and untreated patients. Separate simulations for gender-, age- and QoL-AGHDA- groups were performed and gains in life-years and QALYs (quality adjusted life years) were calculated. Incremental cost-effectiveness ratios (ICER) were assessed for each subgroup. The overall ICER was calculated as the weighted mean of all subgroup ICERs. Data on untreated GHD patients (n=2135) were obtained from Swedish national registers and on GH treated patients (n=550) from the KIMS database (Pfizer International Metabolic Database). All patients had GHD due to non-functioning pituitary adenoma. The cost-effectiveness is presented as incremental costs per QALY gained.

Results: Direct costs for GH-treated patients compared with non-treated patients were higher by SEK421851 (€44 405) and SEK534694 (€56 284) for men and women respectively. This difference was smaller when indirect costs were included: in men SEK410974 (€43 260) and in women SEK500263 (€52 659). Mean incremental life-years gained was 3.4 (men) and 2.7 (women). Mean gains in QALYs were 3.0 (men) and 2.8 (women). Excluding indirect costs, the overall ICER were SEK139047 (€14 637) and SEK205850 (€21 668) for men and women, respectively. Including indirect costs, corresponding values were SEK125683 (€13 230) and SEK150588 (€15 851). Key determinants of the results were improvement in quality of life, increased survival and GH costs.

Conclusions: GH treatment (Genotropin) in adult patients with GHD is cost-effective in relation to informal Swedish thresholds where incremental cost per QALY gained between 100 000 (€10 526) and 500000SEK (€52 631) is considered moderate.