Cost-consequence analysis for recombinant human growth hormone treatment administered via different devices in children in Spain

Abstract

Objetives: To compare height gain and treatment costs of the treatment with recombinant human growth hormone (r-hGH), administered either by Easypod® —an electronic injection allowing adherence monitoring— or other conventional devices licensed in Spain (non-Easypod®) in children and adolescents with growth hormone deficiency. Methods: The analysis was based on a patient-level simulation model including a decision tree and a Markov model; the Markov model represented the different levels of r-hGH use (adherent, non-adherent, and treatment interruption), whereas the decision tree categorized patients according to their r-hGH response. Model characteristics were adapted to Spanish standards and validated through an expert panel. Average costs per cm gained were estimated for each comparator (Easypod® versus non-Easypod®). Different alternative scenarios were performed to analyze the impact of varying individual parameters on the results. Results: For a mean of 10.4 years of treatment, patients receiving r-hGH via Easypod® gained, on average, 19.1 cm (final height: 165.1 cm) compared with 14.8 cm (final height: 160.8 cm) for the comparators (non-Easypod®); resulting in a difference of 4.3 cm. During treatment, patients on Easypod® arm were adherent for a longer time than comparators (52.4% versus 22.2% of the time), involving greater pharmacological costs for Easypod®. Despite greater costs, Easypod® was associated with the lowest cost per cm gained (€3237.0/cm) amongst comparators (non-Easypod®). Costs per cm gained were also lower for Easypod® than for comparators for all the alternative scenarios. Conclusions: The administration of r-hGH with Easypod® improves height gain through better adherence. Easypod® can be the most efficient treatment compared with the other licensed r-hGH treatments in Spain. Keywords: recombinant human growth hormone, device, adherence, cost-consequence analysis.