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Growth hormone (GH) replacement in hypopituitary adults with GH deficiency evaluated by a utility‐weighted quality of life index: a precursor to cost–utility analysis
Author(s) -
KołtowskaHäggström Maria,
Kind Paul,
Monson John P.,
Jonsson Björn
Publication year - 2008
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2007.03010.x
Subject(s) - medicine , cohort , quality of life (healthcare) , population , quality adjusted life year , endocrinology , pediatrics , cost effectiveness , risk analysis (engineering) , nursing , environmental health
Summary Objectives To examine quality of life (QoL) measured by a utility‐weighted index in GH‐deficient adults on GH replacement and analyse the impact of demographic and clinical characteristics on changes in utilities during treatment. Design Utilities for items in the QoL‐Assessment of Growth Hormone Deficiency in Adults (QoL‐AGHDA utility ) were estimated based on data obtained from the general population in England and Wales (E&W). These estimates were used to calculate QoL changes in GH‐treated patients and compare these with normative population values. Patients A total of 894 KIMS patients (53% women) from E&W were followed for 1 to 6 years. Measurements QoL‐AGHDA utility at baseline and at the last reported visit, total QoL‐AGHDA utility gain and QoL‐AGHDA utility gain per year of follow‐up. Results QoL‐AGHDA utility in patients before GH treatment differed from the expected population values [0·67 (SD 0·174) vs. 0·85 (SD 0·038), P < 0·0001], constituting a mean deficit of –0·19 (SD 0·168). There was a difference in the mean QoL‐AGHDA utility deficit for men [–0·16 (SD 0·170)] and women [–0·21 (SD 0·162)] ( P < 0·001). The main improvement occurred during the first year of treatment [reduction of a deficit to –0·07 (SD 0·163) ( P < 0·001) in the total cohort]; however, patients’ utilities remained lower than those recorded for the general population during subsequent follow‐up ( P < 0·001). Despite an observed impact of age, primary aetiology, disease onset and comorbidities on QoL‐AGHDA utility , all patients showed a similar beneficial response to treatment. Conclusions QoL‐AGHDA utility efficiently monitors treatment effects in patients with GHD. The study confirmed the QoL‐AGHDA utility deficit before treatment and a similar QoL‐AGHDA utility gain observed after commencement of GH replacement in all patients.