Growth hormone (GH) consurnption is thc object of a particular attention by regulatory bodies, due ro its financial impact; nevertheless, GH treatment has been demonstrated lo be cost-effective and is, therefore, usually rcirnbursed by public health service systems. In Italy, sig- nificant differences in GH consumption between regions have been recorded. Different appropriateness in real practice is a possible explanation, bUI the proportion of drug wasted due to different combinations 01' rherapeutic regimes and types of devices used in drug administration is a complernentary explanation. Aim 01' t.he srudy is, therefore, to determine how much 01' thc variability in OH consumption is actual1y due to differences in clinica! practice, and how much lo waste. Materials and methods A model was sertled to estimate the population with indication Ior GH adrninistration. separately l'or children, transition subjects and adults, based on both the scientifìc evidence available and directly col- lected c1inical evaluations. A systematic literature scarch was conducted using Cochrane Library (HTA and NHSEE) databascs, Medline via Ovid, Econlit via Ovid, Embase. Conclusion The rnodel applied lo the Italian popularion showcd that there was apparently unexplainable over-pre- scription and porential under-prescription in various regions, ranging frorn 20 lo 40 % less than the estirnated theoretical consumption IO over 200 %. Wastage, at level of single device, could amount to as rnuch as 15 Cf,-; of the consumption, dernonstrating that price per mg is nOI in generai a good proxy of the cost per mg of therapy. Our estirnates of the wastage shows a significant potcntial gap in the rnodel assessrncnt of the HTA bodies, as far as they do uot explicitly take into account the issue of wastage and. consequently, the actual variability in local clinical practice.
The impact of real practice inappropriateness and devices'inefficiency to variability in growth hormone consumption
CASTELLO, ROBERTO;
2014-01-01
Abstract
Growth hormone (GH) consurnption is thc object of a particular attention by regulatory bodies, due ro its financial impact; nevertheless, GH treatment has been demonstrated lo be cost-effective and is, therefore, usually rcirnbursed by public health service systems. In Italy, sig- nificant differences in GH consumption between regions have been recorded. Different appropriateness in real practice is a possible explanation, bUI the proportion of drug wasted due to different combinations 01' rherapeutic regimes and types of devices used in drug administration is a complernentary explanation. Aim 01' t.he srudy is, therefore, to determine how much 01' thc variability in OH consumption is actual1y due to differences in clinica! practice, and how much lo waste. Materials and methods A model was sertled to estimate the population with indication Ior GH adrninistration. separately l'or children, transition subjects and adults, based on both the scientifìc evidence available and directly col- lected c1inical evaluations. A systematic literature scarch was conducted using Cochrane Library (HTA and NHSEE) databascs, Medline via Ovid, Econlit via Ovid, Embase. Conclusion The rnodel applied lo the Italian popularion showcd that there was apparently unexplainable over-pre- scription and porential under-prescription in various regions, ranging frorn 20 lo 40 % less than the estirnated theoretical consumption IO over 200 %. Wastage, at level of single device, could amount to as rnuch as 15 Cf,-; of the consumption, dernonstrating that price per mg is nOI in generai a good proxy of the cost per mg of therapy. Our estirnates of the wastage shows a significant potcntial gap in the rnodel assessrncnt of the HTA bodies, as far as they do uot explicitly take into account the issue of wastage and. consequently, the actual variability in local clinical practice.
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