Gary R. Bazalo, MS
Managed Solutions, Conifer, Colo.
Ashish V. Joshi, PhD
Novo Nordisk, Princeton, N.J.
John Germak, MD
Novo Nordisk, Princeton, N.J.


We assessed the economic impact to the United States payer of recombinant human growth hormone (rhGH) utilization, comparing the relative dosage efficiency of marketed pen-based and vial-based products in a pediatric and in an adult population. A budgetary impact model calculated drug costs based on product waste and cost. Waste was the difference between prescribed dose, based on patient weight, and actual delivered dose, based on dosing increments and maximum deliverable dose for pens and a fixed-percent waste as derived from the literature for vials.

Annual wholesale acquisition costs were calculated based upon total milligrams delivered, using a daily dose of 0.03 mg/kg for pediatric patients and 0.016 mg/kg for adults. Total annual drug costs were compared for two scenarios: 1) a product mix based on national market share and 2) restricting use to the product with lowest waste.

Based on the literature, waste for each vial product was 23 percent. Among individual pens, waste was highest for Humatrope 24 mg (19.5 percent pediatric, 14.3 percent adult) and lowest for Norditropin NordiFlex 5 mg (1.1 percent pediatric, 1 percent adult). Restricting use to the brand with least waste (Norditropin), compared to national product share mix, resulted in a 10.2 percent reduction in annual pediatric patient cost from $19,026 to $17,089 and an 8 percent reduction in annual adult patient cost from $24,099 to $22,161.

We concluded that pen delivery systems result in less waste than vial and syringe. Considering all approved delivery systems, Norditropin resulted in the least product waste and lower annual patient cost for both pediatric and adult populations.

Corresponding author:
Gary R. Bazalo, MS
Managed Solutions
28154 Belle Meade Drive
Conifer, Colo. 80433

Gary R. Bazalo, MS, discloses that he is a consultant to Novo Nordisk.
Ashish V. Joshi, PhD, and John Germak, MD, disclose that they are employees of Novo Nordisk.

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