Three-year experience with access to nationally funded growth hormone (GH) replacement for GH-deficient adults

ObjectiveTreatment of growth hormone (GH)-deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported. DesignRetrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists. PatientsApplications for 201 patients were assessed and 191 approved for funded treatment over the initial 3years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary. ResultsAfter an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA((R)) instrument (baseline (95%CI) 19 (18-21), 9months 6 (5-75)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2806cm. The mean maintenance GH dose after 9months of treatment was 039mg/day. After 3years, 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9months of treatment. ConclusionCarefully designed access to nationally funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.