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
Department of Environmental Health Sciences, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita-shi, Akita, 010-8543, Japan.
Division of Health Services Research, Center for Cancer Control and Information Services, The National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
BMC Health Serv Res. 2016 Oct 21;16(1):602. doi: 10.1186/s12913-016-1854-z.
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.
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.
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.
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.
在日本，如果儿童符合临床标准，包括身高限制（男孩：156.4厘米；女孩：145.4厘米），生长激素（GH）缺乏症儿童的治疗费用由政府补贴。然而，一些资助项目，如地方政府提供的补贴，可供那些超过身高限制的人使用。在本研究中，我们利用这种自然分配方式探讨了经济支持对GH治疗的影响。
对696名达到身高限制的青少年患者（451名男孩和245名女孩）进行回顾性分析。使用多因素逻辑回归分析评估经济支持与继续治疗之间的关联，并对年龄、性别、身高、生长速度、骨龄和不良反应进行校正。
在分析的696名儿童中，108名（15.5%）仍有资格获得经济支持。有资格获得支持的儿童继续接受GH治疗的比例高于无资格获得支持的儿童（75.9%对52.0%，P<0.001）。在调整人口统计学特征和临床因素后，男孩继续治疗的经济支持优势比为4.04（95%置信区间[CI]：1.86-8.78），女孩为1.72（95%CI：0.80-3.70）。
经济支持影响了GH缺乏症儿童继续治疗的决策。经济支持资格的地域差异带来了一个伦理问题，需要政策关注。应探索在治疗延续的公共支出与由此带来的生活质量改善之间取得适当平衡。
