Supplement
Issue:
Growth Hormone Treatment: Balancing Cost, Safety, and Outcome in a Managed Care Environment [CME/CPE/CNE]
Volume:
17
Number:
18 Suppl
Release date: December 15, 2011  |  Expiration date: December 31, 2012
Estimated time to complete activity: 1.5 hours
Type of Activity: Knowledge-based  |  Media: Journal supplement 

This activity is supported by an educational grant from Novo Nordisk, Inc.

Intended Audience
This activity has been designed to meet the educational needs of healthcare professionals involved in the management of patients with growth hormone deficiency and growth-related disorders, as well as medical directors, pharmacy directors, clinical pharmacists, quality directors, care managers, registered nurses, and other managed care and payer organization professionals.

Statement of Educational Need/Program Overview
The development of recombinant human growth hormone (rhGH) and an expansion of its indications have led to accelerating use of growth hormone (GH) therapy. To provide well-intentioned coverage and safe and effective treatments to members who need it most, health plans must ensure that the indications for which they cover rhGH therapy are medically necessary, safe, and beneficial. The use of rhGH helps to correct the physiologic, metabolic, functional, and psychologic challenges associated with growth hormone deficiency (GHD) and short stature.

Supplementation with rhGH has been approved and shown to be effective and safe when used to increase GH levels, and to improve adult height and metabolism in patients with GHD as well as those with genetic syndromes associated with short stature such as Turner, Prader-Willi, and Noonan syndromes. Patients with idiopathic short stature and children who are born small for gestational age have also been shown to achieve normalization of adult height with GH supplementation, and children with growth retardation secondary to chronic renal insufficiency experience an increase in linear growth, bone mineral density, body weight, and lean mass. Furthermore, the use of rhGH is effective therapy for adults with known pituitary disease or risk factors for hypopituitarism, such as severe head trauma or pituitary irradiation, provided that GHD is proven.

Educational Objectives
After completing this activity, the participant should be better able to:
  • Describe clinical and psychosocial implications for health plan patients with GHD and growth-related disorders
  • Integrate evolving GH replacement treatment guidelines with a managed care algorithm for optimal value of therapeutic options
  • Outline evidence-based treatment decisions for patients requiring GH replacement therapy in a managed care setting
  • Use decision support tools and techniques to determine the cost-effectiveness of rhGH therapies
  • Compare and contrast the most recent administration and adherence data for rhGH devices that lead to enhanced patient value for the treatment of GHD and growth-related disorders
  • Provide accurate and appropriate counsel as part of the treatment team
  • Provide appropriate care and counsel for patients and their families

Physician Continuing Medical Education
Accreditation Statement / Credit Designation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and Impact Education, LLC. Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Continuing Education
Accreditation Statement / Credit Designation
Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Postgraduate Institute for Medicine designates this continuing education activity for 1.5 contact hours (0.15 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number - 0809-9999-11-131-H01-P).

Nurse Continuing Education
Credit Designation / Accreditation Statement
This educational activity for 1.3 contact hours is provided by Postgraduate Institute for Medicine.

Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. A statement of credit will be issued only upon receipt of a completed activity evaluation form.

Method of Participation and Request for Credit
There are no fees for participating in and receiving CME/CPE/CNE credit for this activity. During the period December 15, 2011, through December 31, 2012, participants must read the learning objectives and faculty disclosures and study the educational activity.

Postgraduate Institute for Medicine supports Green CME by offering your Request for Credit online. If you wish to receive acknowledgment for completing this activity, please complete the posttest and evaluation on www.cmeuniversity.com. On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 8343. Upon registering and successfully completing the posttest with a score of 70% or better and the activity evaluation, your certificate will be made available immediately. Processing credit requests online will reduce the amount of paper used by nearly 100,000 sheets per year.

Faculty
Jeffrey D. Dunn, PharmD, MBA
Formulary and Contract Manager, SelectHealth, Inc - Salt Lake City, UT

Nancy A. Nickman, PhD
Professor of Pharmacotherapy, Presidential Teaching Scholar, Department of Pharmacotherapy and Pharmacotherapy, Outcomes Research, University of Utah - Salt Lake City, UT

Alan D. Rogol, MD, PhD
Professor of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine - Indianapolis, IN
Professor Emeritus, University of Virginia - Charlottesville, VA

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty Disclosures
Within the past 12 months, the faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Jeffrey D. Dunn, PharmD, MBA
Consultant/advisory board member: Novo Nordisk, Inc

Nancy A. Nickman, PhD
Grants/research support: Novartis Pharmaceuticals

Alan D. Rogol, MD, PhD
Consultant/advisory board member: Abbott Laboratories, Insmed Incorporated, Ipsen, and Novo Nordisk, Inc; Stock ownership (self & spouse): Insmed Incorporated

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have had with commercial interests related to the content of this CME activity:

Steve Casebeer, MBA; Jan Hixon, RN, BSN, MA; Trace Hutchison, PharmD; Julia Kimball, RN, BSN; Samantha Mattiucci, PharmD; Jan Schultz, RN, MSN, CCMEP; and Patricia Staples, MSN, NP-C, CCRN, hereby state that they or their spouse/life partner have not had any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The American Journal of Managed Care has no relevant financial relationships to disclose. Signed disclosures are on file at the office of The American Journal of Managed Care, Plainsboro, NJ.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Postgraduate Institute for Medicine (PIM), Impact Education, LLC (IE), and Novo Nordisk, Inc do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, IE, or Novo Nordisk. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

The contents of this supplement may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.

System Requirements
PC-based participants
Required: Windows® 7, Vista, XP, 2003 Server or 2000

Macintosh®-based participants
Required: Mac OS® X 10.4.11 (Tiger®) or newer

© 2011 Managed Care & Healthcare Communications, LLC
ARTICLES
Jeffrey D. Dunn, PharmD, MBA; and Nancy A. Nickman, PhD
Alan D. Rogol, MD, PhD
Nancy A. Nickman, PhD; and Jeffrey D. Dunn, PharmD, MBA
AUTHOR INDEX
CE/CME QUIZ