The cost-effectiveness of growth hormone replacement therapy (Genotropin®) in hypopituitary adults in Sweden

BACKGROUND: To evaluate the cost-effectiveness of growth hormone (GH) treatment (Genotropin(R)) compared with no GH treatment in adults with GH deficiency in a Swedish societal setting. METHODS: A Markov-type cost-utility simulation model was constructed and used to simulate, for men and women, morbidity and mortality for GH-treated and -untreated individuals over a 20-year period. The calculations were performed using current available prices concerning morbidity-related healthcare costs and costs for Genotropin(R). All costs and treatment effects were discounted at 3%. Costs were expressed in Euro (1[euro sign] = 9.03 SEK). GH-treated Swedish patients (n = 434) were identified from the KIMS database (Pfizer International Metabolic Database) and untreated patients (n = 2135) from the Swedish Cancer Registry and the Hospital Discharge Registry. RESULTS: The results are reported as incremental cost per quality-adjusted life year (QALY) gained, including both direct and indirect costs for GH-treated versus untreated patients. The weighted sum of all subgroup incremental cost per QALY was [euro sign]15,975 and [euro sign]20,241 for men and women, respectively. Including indirect cost resulted in lower cost per QALY gained: [euro sign]11,173 and [euro sign]10,753 for men and women, respectively. Key drivers of the results were improvement in quality of life, increased survival, and intervention cost. CONCLUSIONS: The incremental cost per QALY gained is moderate when compared with informal thresholds applied in Sweden. The simulations suggest that GH-treatment is cost-effective for both men and women at the [euro sign]55,371 (SEK 500,000 -- the informal Swedish cost-effectiveness threshold) per QALY threshold.