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Craig D, Fayter D, Stirk L, et al. Growth Monitoring for Short Stature: Update of a Systematic Review and Economic Model. Southampton (UK): NIHR Evaluation, Trials and Studies Coordinating Centre (UK); 2011 Feb. (Health Technology Assessment, No. 15.11.)

Cover of Growth Monitoring for Short Stature: Update of a Systematic Review and Economic Model

Growth Monitoring for Short Stature: Update of a Systematic Review and Economic Model.

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6Conclusions

Implications for service provision

Both this report and the previous assessment2 suggest that monitoring for short stature is a cost-effective option. Further, we know that some monitoring already takes place in the form of the NCMP, but the primary focus of this programme is not on identifying children with short stature. What remains unclear is how monitoring for short stature and the type of monitoring undertaken by the NCMP might be linked. We have identified limited evidence to support any particular strategy for short stature monitoring and no evidence for the implementation or delivery of such a programme. Our economic modelling is highly speculative and does not provide any useful additional information with which to inform a decision about which monitoring programme to use.

We hope that this report contributes further knowledge, but we acknowledge that it does not provide definitive answers. In particular, we were unable to establish current practice or evaluate optimal referral cut-offs and age(s) at which to screen. The results obtained are logical in the sense that referring more children results in a higher detection rate and thereby a higher ICER, but they cannot be interpreted as definitive answers.

Given that the NCMP is a well-established service, consideration should be given to the impact of incorporating growth monitoring and referral for short stature. This does not negate the decision of which referral strategy is optimal and further research would still be required to answer this question.

Suggested research priorities

In our previous assessment2 we suggested long-term research on growth monitoring in the form of controlled trials comparing growth monitoring with no growth monitoring. We also suggested studies of diagnostic accuracy following up both children found to be short and those found to be normal. We have identified some research priorities that may help inform the evidence base and these are listed below. However, our previous long-term research priorities recommended in the previous assessment2 remain valid.

  • Conduct an assessment of current referral sources for short stature (i.e. GP, school nurse, parents).
  • Conduct a retrospective data analysis of a large sample of UK children currently referred for short stature to assess the identification rate of diagnosis of disease.
  • Survey current clinical referral pathways and diagnostic work-up and final diagnosis for children referred for short stature.
  • Survey the attitudes of health-care professionals, parents and children to a national growth monitoring programme to identify possible barriers to implementation.
  • Investigate the feasibility of integrating growth monitoring for short stature into the NCMP.
  • Monitor any introduction of a programme for quality assurance to decrease referral errors and false negatives.
  • Undertake an assessment of QoL and utilities for children diagnosed with disorders of short stature, preferably at referral and during and after treatment.
© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK100726
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