Effects of financial support on treatment of adolescents with growth hormone deficiency

A retrospective study in Japan

Eri Maeda, Takahiro Higashi, Tomonobu Hasegawa, Susumu Yokoya, Takahiro Mochizuki, Tomohiro Ishii, Junko Ito, Susumu Kanzaki, Akira Shimatsu, Koji Takano, Toshihiro Tajima, Hiroyuki Tanaka, Yusuke Tanahashi, Akira Teramoto, Toshiro Nagai, Kunihiko Hanew, Reiko Horikawa, Toru Yorifuji, Naohiro Wada, Toshiaki Tanaka

Research output: Contribution to journalArticle

Abstract

Background: Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. Methods: A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. Results: Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 % vs. 52.0 %, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 % confidence interval [CI]: 1.86-8.78) in boys and 1.72 (95 % CI: 0.80-3.70) in girls, after adjusting for demographic characteristics and clinical factors. Conclusions: Financial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.

Original languageEnglish
Article number602
JournalBMC Health Services Research
Volume16
Issue number1
DOIs
Publication statusPublished - 2016 Oct 21
Externally publishedYes

Fingerprint

Financial Support
Growth Hormone
Japan
Retrospective Studies
Therapeutics
Confidence Intervals
Local Government
Bone Development
Health Care Costs
Logistic Models
Odds Ratio
Regression Analysis
Quality of Life
Demography

Keywords

  • Children with special health care needs
  • Health insurance
  • Japan
  • Public funding

ASJC Scopus subject areas

  • Health Policy

Cite this

Effects of financial support on treatment of adolescents with growth hormone deficiency : A retrospective study in Japan. / Maeda, Eri; Higashi, Takahiro; Hasegawa, Tomonobu; Yokoya, Susumu; Mochizuki, Takahiro; Ishii, Tomohiro; Ito, Junko; Kanzaki, Susumu; Shimatsu, Akira; Takano, Koji; Tajima, Toshihiro; Tanaka, Hiroyuki; Tanahashi, Yusuke; Teramoto, Akira; Nagai, Toshiro; Hanew, Kunihiko; Horikawa, Reiko; Yorifuji, Toru; Wada, Naohiro; Tanaka, Toshiaki.

In: BMC Health Services Research, Vol. 16, No. 1, 602, 21.10.2016.

Research output: Contribution to journalArticle

Maeda, E, Higashi, T, Hasegawa, T, Yokoya, S, Mochizuki, T, Ishii, T, Ito, J, Kanzaki, S, Shimatsu, A, Takano, K, Tajima, T, Tanaka, H, Tanahashi, Y, Teramoto, A, Nagai, T, Hanew, K, Horikawa, R, Yorifuji, T, Wada, N & Tanaka, T 2016, 'Effects of financial support on treatment of adolescents with growth hormone deficiency: A retrospective study in Japan', BMC Health Services Research, vol. 16, no. 1, 602. https://doi.org/10.1186/s12913-016-1854-z
Maeda, Eri ; Higashi, Takahiro ; Hasegawa, Tomonobu ; Yokoya, Susumu ; Mochizuki, Takahiro ; Ishii, Tomohiro ; Ito, Junko ; Kanzaki, Susumu ; Shimatsu, Akira ; Takano, Koji ; Tajima, Toshihiro ; Tanaka, Hiroyuki ; Tanahashi, Yusuke ; Teramoto, Akira ; Nagai, Toshiro ; Hanew, Kunihiko ; Horikawa, Reiko ; Yorifuji, Toru ; Wada, Naohiro ; Tanaka, Toshiaki. / Effects of financial support on treatment of adolescents with growth hormone deficiency : A retrospective study in Japan. In: BMC Health Services Research. 2016 ; Vol. 16, No. 1.
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abstract = "Background: Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. Methods: A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. Results: Of the 696 children in the analysis, 108 (15.5 {\%}) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 {\%} vs. 52.0 {\%}, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 {\%} confidence interval [CI]: 1.86-8.78) in boys and 1.72 (95 {\%} CI: 0.80-3.70) in girls, after adjusting for demographic characteristics and clinical factors. Conclusions: Financial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.",
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T2 - A retrospective study in Japan

AU - Maeda, Eri

AU - Higashi, Takahiro

AU - Hasegawa, Tomonobu

AU - Yokoya, Susumu

AU - Mochizuki, Takahiro

AU - Ishii, Tomohiro

AU - Ito, Junko

AU - Kanzaki, Susumu

AU - Shimatsu, Akira

AU - Takano, Koji

AU - Tajima, Toshihiro

AU - Tanaka, Hiroyuki

AU - Tanahashi, Yusuke

AU - Teramoto, Akira

AU - Nagai, Toshiro

AU - Hanew, Kunihiko

AU - Horikawa, Reiko

AU - Yorifuji, Toru

AU - Wada, Naohiro

AU - Tanaka, Toshiaki

PY - 2016/10/21

Y1 - 2016/10/21

N2 - Background: Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. Methods: A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. Results: Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 % vs. 52.0 %, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 % confidence interval [CI]: 1.86-8.78) in boys and 1.72 (95 % CI: 0.80-3.70) in girls, after adjusting for demographic characteristics and clinical factors. Conclusions: Financial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.

AB - Background: Treatment costs for children with growth hormone (GH) deficiency are subsidized by the government in Japan if the children meet clinical criteria, including height limits (boys: 156.4 cm; girls: 145.4 cm). However, several funding programs, such as a subsidy provided by local governments, can be used by those who exceed the height limits. In this study, we explored the impacts of financial support on GH treatment using this natural allocation. Methods: A retrospective analysis of 696 adolescent patients (451 boys and 245 girls) who reached the height limits was conducted. Associations between financial support and continuing treatment were assessed using multiple logistic regression analyses adjusting for age, sex, height, growth velocity, bone age, and adverse effects. Results: Of the 696 children in the analysis, 108 (15.5 %) were still eligible for financial support. The proportion of children who continued GH treatment was higher among those who were eligible for support than among those who were not (75.9 % vs. 52.0 %, P < 0.001). The odds ratios of financial support to continuing treatment were 4.04 (95 % confidence interval [CI]: 1.86-8.78) in boys and 1.72 (95 % CI: 0.80-3.70) in girls, after adjusting for demographic characteristics and clinical factors. Conclusions: Financial support affected decisions on treatment continuation for children with GH deficiency. Geographic variations in eligibility for financial support pose an ethical problem that needs policy attention. An appropriate balance between public spending on continuation of therapy and improved quality of life derived from it should be explored.

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KW - Public funding

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