Clinical effectiveness and cost-effectiveness of growth hormone in children: a systematic review and economic evaluation

Summary of benefits Although the quality of evidence proved variable, thestudies suggest that GH treatment can increase short-term growth and improve final height. The reportedeffects of GH on short-term growth should be consid-ered more reliable because the evidence is of higherquality. The effects of GH on final height should beconsidered with much greater caution because thequality of the studies is generally much poorer. Results suggest that the effects of GH on short-term growth velocity (at 1 year) can range from no improvement to approximately 1 standarddeviation above the normal growth velocity forchildren of the same age.Final height gains for treated children over un-treated children appear to range from approxi-mately 2 to 11 cm (GHD, 8–11 cm; TS, 5 cm; CRF, 3–9 cm; PWS, 10–11 cm; ISS, 2–7 cm). Costs Treatment with GH is expensive. The lifetimeincremental cost of treating one child with GH (asopposed to simply monitoring growth) ranges from£43,100–53,400 (for GHD) to £55,500–83,000 (for PWS). These costs, when applied to childrenaged 8–15 years with the analysed indications inEngland and Wales, result in total discounted costsof £904 million for complete treatment. The costsfor treating children only in the four licensedconditions would be approximately £180 million.