Patients bear an increased financial burden for growth hormone treatment despite FDA approval

Despite FDA approval of growth hormone treatment for idiopathic small-sized children (ISS), average costs for patients and their families have increased over time, according to researchers' findings of the Philadelphia Children's Hospital (CHOP) and the Leonard Davis Institute of Health Economics (LDI) of the University of Pennsylvania. The results were presented at ENDO 2019 in New Orleans, LA.

The results of the study indicate that increased cost sharing and limiting patient coverage are causing a heavier financial burden for families and not necessarily for insurance companies, which have seen their hormone costs of growth decrease per patient during the same period.

Growth hormone has been approved by the US Food and Drug Administration (FDA) for treatment of the ISS in 2003, which has increased the potential availability of growth hormone in a child. 3,500 suffering from growth hormone deficiency up to 1.2% of the US population. However, over the past decade, insurance companies have progressively narrowed growth hormone coverage, including adopting form preference strategies and stricter coverage criteria, as well as prohibiting any coverage of growth hormone coverage. growth hormone for treatment with ISS.

"As growth hormone is a very expensive drug that requires years of daily injections, insurance providers are increasingly inclined to limit costs and erode patient-physician decision-making autonomy and clinical care, "said Adda Grimberg, MD, pediatric endocrinologist and Scientific Director of the CHOP Growth Center, professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania and lead author of the study. "It was important for us to understand the extent of the impact of these restrictions imposed by insurance companies on families and the overall use of growth hormone. "

Using administrative claims data between 2001 and 2016, the study found that the number of growth hormone prescriptions increased from 5.1 patients per 10,000 beneficiaries in 2001 to 14.6 in 10,000, although no dramatic change was observed in 2003, when growth hormone was approved by the FDA. for ISS. While total spending on growth hormone per patient has decreased, as has the estimated amount of insurance, average payments, deductibles and the total financial burden of patient families have increased by 234% in nominal terms. and 161% in real dollars. The insurance data also showed an increase in the frequency of growth hormone brand change.

"Since different brands of growth hormones use different injection devices, brand switching poses an additional burden for the patient's family: stress and anxiety related to change, possibility of interruption treatment, mandatory reconversion of the new device (s) and risk of dosage error, "says Grimberg. "While the restrictions and the progressive coverage forms have reduced the total cost and burden of insurers related to growth hormone treatment, these savings have not been pbaded on to patients."

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Philadelphia Children's Hospital