Healthcare utilization, quality of life and patient-reported outcomes during two years of GH replacement therapy in GH-deficient adults – comparison between Sweden, The Netherlands and Germany

Abstract

*On behalf of the German KIMS investigators; †On behalf of the Dutch KIMS investigators; ‡On behalf of the Swedish KIMS investigators.(Correspondence should be addressed to B Saller; EndoScience Endokrinologie Service GmbH, Thalkirchner Str. 1, 80337 Munich, Germany; Email: saller@endoscience.de) AbstractObjective: This study set out to determine the change in quality of life (QoL) and healthcare utilization during 2 years of growth hormone (GH) replacement therapy in adults with GH deficiency. Data were compared from three European countries. Design: Analysis was made from KIMS, the Pfizer International Metabolic Database on adult GH deficiency. Methods: QoL and healthcare utilization were measured at baseline and after 1 and 2 years of GH replacement in patient cohorts from Sweden (n Z302), The Netherlands (n Z103) and Germany (n Z98). QoL was assessed by the QoL-Assessment in Growth Hormone Deficient Adults (QoL-AGHDA) questionnaire, and the KIMS Patient Life Situation Form was used to evaluate healthcare utilization. Results: QoL improved significantly (P ! 0.0001) and comparably in all three cohorts. The improvement was seen during the first year of treatment and QoL remained improved during the second year. The number of days in hospital was reduced by 83% (P ! 0.0001) during GH replacement. There were no country-specific differences either at baseline or during follow-up. The same was true for the number of days of sick leave (reduction of 63%; P Z 0.0004). Significant reductions were recorded in the number of doctor visits in each of the three cohorts after 2 years of GH replacement (P ! 0.05). Conclusions: This study provides a detailed comparative analysis of GH replacement therapy in GHD patients in three European countries. Despite some differences in treatment strategies, the beneficial effects on QoL, patient-reported outcomes and healthcare utilization are essentially similar in the healthcare environment of Western European countries.European Journal of Endocrinology 154 843-850

Assessment of quality of life in adult patients with GH deficiency: KIMS contribution to clinical practice and pharmacoeconomic evaluations

“…Level of and satisfaction with leisure physical activity increased and was correlated with improvement in QoL, but there was no relation between changes in QoL-AGHDA scores and consumption of healthcare resources. These findings were concordant with the results obtained in the German and Dutch cohorts during 2 years of GH treatment (34).…”

“…Similar results were consistently reported from subsequent studies in the total KIMS population (43) as well as in different cohorts such as patients aged below and above 65 years (46), originating from a single country (34,36,37,47,48), and those who developed GHD following treatment for acromegaly and Cushing's disease (49), childhoodonset (CO) craniopharyngioma (50), adult-onset (AO) non-functioning pituitary adenoma (NFPA) (51) and CO-brain tumours (52). The only exceptions are patients with AO-craniopharyngioma (50) and with CO-GHD due to causes other than craniopharyngioma and brain tumours (52) in whom a gender difference in QoL was not observed.…”

“…The only exceptions are patients with AO-craniopharyngioma (50) and with CO-GHD due to causes other than craniopharyngioma and brain tumours (52) in whom a gender difference in QoL was not observed. Some studies showed similar rates of change in QoL during the treatment in both genders (34,43).…”

“…For the studies on the QoL-AGHDA, adaptation for health economic evaluations EQ-5D (33) was additionally employed. The patient's situation is recorded by the KIMS Patient Life Situation Form (KIMS PLSF) (34).…”

Adult GH deficiency throughout lifetime

“…3). Poor baseline QoL-AGHDA score predicts a greater psychosocial response to GH replacement (65). There seems to be no difference in improvement in QoL in adult patients of different ages, with older patients deriving as much benefit from GH replacement as those who are younger (27,36,39) (Fig.…”