Consequences of brand switches during the course of pediatric growth hormone treatment

Endocr Pract. May-Jun 2012;18(3):307-16. doi: 10.4158/EP11217.OR.


Objective: To explore the effects of insurance-mandated brand switches during the course of pediatric recombinant human growth hormone (rhGH) treatment on clinical practice.

Methods: We e-mailed a 9-question, anonymous, Internet-based survey to active members of the Pediatric Endocrine Society. The survey consisted of multiple-choice and yes/no answers. Free-text comments were solicited for further explanation of responses. Quantitative answers were tabulated. Each investigator independently coded the free-text responses; themes based on codes identified by all 3 investigators in a minimum of 5 different respondents' comments were compiled and organized.

Results: Of the 812 active members of the Pediatric Endocrine Society who were e-mailed the survey, 231 responded. Two hundred eight respondents reported switching a patient's regimen from one rhGH product to another, and of these, 50% experienced repeated switches. Switches occurred for each commercially available rhGH brand. Frequent concerns noted by respondents involved dosing errors and treatment lapses from having to learn a new device and impaired adherence related to patient-family frustration and anxiety. Anti-GH antibodies, measured by only 3 endocrinologists when switching a patient's regimen from one brand to another, were negative before and after the product switch. When a patient switched rhGH brands, the most frequently reported time involvement for endocrine office staff was 2 hours for paperwork, 1 hour for device instruction, and 1 hour for "other" (mostly related to telephone reassurance).

Conclusion: GH brand switches may adversely affect patient care and burden pediatric endocrinology practices.

MeSH terms

  • Child
  • Cost Savings
  • Cost of Illness
  • Drug Costs
  • Drug Utilization / economics
  • Family
  • Formularies as Topic*
  • Human Growth Hormone / adverse effects
  • Human Growth Hormone / economics
  • Human Growth Hormone / therapeutic use*
  • Humans
  • Insurance, Pharmaceutical Services* / economics
  • Internet
  • Medication Adherence
  • Patient Education as Topic / economics
  • Patient Satisfaction
  • Practice Patterns, Physicians'* / economics
  • Recombinant Proteins / adverse effects
  • Recombinant Proteins / economics
  • Recombinant Proteins / therapeutic use
  • Surveys and Questionnaires
  • Time Factors
  • United States


  • Recombinant Proteins
  • Human Growth Hormone