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Adult growth hormone deficiency treatment is safe and effective, but who is tracking the social and economic impact, reviewers ask?
Patients with adult growth hormone deficiency (AGHD) who receive early and sustained growth hormone replacement (GHR) therapy are likely to benefit from improved quality of life and reduced disease-related economic burden, but studies have yet to examine the direct cost or caregiver burden of the disease, according to a recent literature review published in Current Medical Research and Opinion.
“Despite a wealth of information on the efficacy and safety of treatments for GHD, only a small number of studies reported on the humanistic and economic burden, and none reported data on the direct costs or caregiver burden of the disease-making it difficult to build a full and accurate picture of the impact of AGHD,” Jane Loftus, from Pfizer Ltd in Surrey, United Kingdom, and colleagues wrote in their review.
Burden is broad, poorly studied
Although the researchers found significant evidence of the positive impact of regular treatment for individuals with AGHD, they noted there were only 14 studies between January 2006 and July 2016 that met inclusion criteria of studying the humanistic and economic burden of AGHD. Of these, 7 studies were 5-years-old, and no study had looked at the economic burden associated with AGHD since 2014.
Seven studies used the Quality of Life-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) instrument, which measured health-related QoL (HR-QoL) outcomes such as cognitive function, emotional functioning, social functioning, motivation, sleep, and physical impact. In 4 studies, HR-QoL was significantly impaired in AGHD patients at baseline compared with the general population as measured by QoL-AGHDA scores and 5 studies showed worse HR-QoL in women compared with men.
Energy, vitality most consistently impaired
The negative impact on HR-QoL of untreated AGHD was underscored in 2 of the studies reviewed. Researchers found memory and concentration domains are most impaired, followed by tiredness, self-confidence, tenseness, and socialization issues. In one study, 91% of AGHD patients reported energy and vitality were the domains most consistently affected, and other patients frequently reported symptoms of anxiety, social isolation, and depressed mood.
Treatment results tend to plateau
Eight studies examined the effect of GHR therapy on HR-QoL, with results showing an improvement in QoL-AGHDA scores of 2.3 and 5.3 points. The QoL-AGHDA scale includes 25 statements responded to with “Yes” or “No.” A score can range from 0 to 25 with higher scores indicating poor QoL. In 2 studies, issues that were least impaired improved first such as socialization issues, tenseness, and self-confidence, while tiredness, and memory and concentration were among the last symptoms to improve.
Short-term improvement in QoL was seen in 4 studies, with tiredness, memory and concentration improving after 1 year; results tended to plateau after the first year and in the long-term, improvement was dependent upon factors such as European origin, lack of depression history, lower body mass index, and no impaired vision at baseline.
With regard to the health economic impact of AGHD treatment, economic burden was associated with “productivity losses related to the disease” such as lower working capacity related to days off for sickness and a higher unemployment rate. After successful GHR therapy, patient productivity is substantially improved and so economic loss is reduced. Specific improvements noted in one study after 12 months of GHR therapy included increased physical activity and decreased need for assistance with activities of daily living; these measures correlated with improved Qol, as measured by QoL-AGHDA, and a reduction in the number of sick days from work, visits to a doctor, hospital stays, and use of healthcare resources.
The authors conclude that the results of their review underscore the need for additional research that will help optimize patient management and outcomes, particularly given the increasing need to better manage health care resources.
Source: Loftus J, Camacho-Hubner C, Hey-Hadavi J, et al. Targeted literature review of the humanistic and economic burden of adult growth hormone deficiency. Curr Med Res Opin. 2018 Nov 9.