Costs of Including Growth Hormone Replacement Therapy into the Universal Coverage Benefit Package of Thailand

Growth hormone replacement therapy (GHRT) is an expensive health service excluded from the universal coverage (UC) benefit package of Thailand. Its high costs and exclusion from the UC benefit package prevent poor patients from access to such health care. This study aims to estimate costs of providing GHRT to patients diagnosed with growth hormone deficiency (GHD). It also explores demand for and supply of, and total costs per unit of height increase from universal access to GHRT. Methods include comprehensive literature review, in-depth interviews of childhood endocrinologists from three university hospitals about costs of GHRT and its current practice, and modeling costs for height increase using different products. Research findings indicate the incidence of GHD in Thailand is approximately 1 to 50,000 of people aged less than 15 years. A weekly dosage of GHRT recommended by the Thai Pediatric Endocrine Society range from 0.1 to 0.3 mg per kg depending on patient's responses. Cessation criteria of GHRT comprise a) attainment of adult height at 165 and 155 cm in male and female respectively, b) bone age above 16 and 14 years in male and female respectively, and c) the annual increase of height lower than 2.5 cm. On supply side, approximately 40 Pediatric Endocrinologists are available in public and private settings across the country. Costs of GHRT are varied from factors including patient’s age and gender, type and dose of GH use. Data from a university hospital show costs of GHRT range from 950 to 2580 USD per every 1 cm of height increase when using a cheaper GH product. The costs will increase from 1460 to 4000 USD per every 1cm of height increase when using the original GH. High cost burden of GHRT poses a challenging question on whether it should be included in the UC benefit package