Table 2

Key characteristics summary of included human growth hormone (hGH) deficiency studies

Method studied/referenceCountryParticipant characteristicsOutcomes accessedPreferred treatment characteristicsAssociated analytical theme
Family choice of injection devices for GH therapy
11
UKChildren and their parents attending a paediatric endocrine clinic (n=56). Median age of 13 yearsKey attributes associated with utility levels using computer-based interviews
  • Lack of bruising, autoinjection (device feature) and lack of pain.

  • Least important factor was home delivery of drugs and nurse support at home

  • Ease of use

  • Tolerability of injection

  • Home/healthcare interface

Evaluation of a pen injector for GH17New ZealandChildren and parents of children on hGH treatment (n=77)Via questionnaires, subjects perception of associated benefits, adequacy of instructions, satisfaction of information and response to treatment
  • Preference for pen due to: self-administration, device characteristics (convenience and comfort) and instruction quality

  • Ease of use

  • Patient/caregiver agency

Disposable self-injector pen vs reusable pen for administration of hGH
18
USAChildren and their caregivers (n=91 boys, 45 girls). Mean age of 12.3 yearsInjection Pen Assessment Questionnaire (IPAQ), accessed ease of use, convenience, education and preference
  • Preference for disposable pen was due to: preparation ease, ease of use and administration characteristics

  • Ease of use

Comparison of three injection devices: Norditropin FlexPro Pen (FP), Genotropin GoQuick (GQ), Norditropin NordiFlex (NF) 21GermanySubjects diagnosed with GHD, TS or short stature (n=64). Age range: >10 to <18 years oldSubjects device preferences regarding device features, overall ease of learning, ease of use and preference using a series of questionnaires
  • FP was easier to use and learn

  • Ease of use

Needle-free device with a lower injection volume22The NetherlandsSubjects who had been prescribed standard GHT and standard care (n=73). Mean age 10 years (SD 3.6 years)Satisfaction, ease and frequency of reconstitution, painful sensations/bruising during administration and preference were measured through a questionnaire and diary
  • New device preference due to ease of use, lower pain/bruises and self-administration

  • Ease of use

  • Tolerability of injection

Treatment experience of NordiFlex device23South KoreaPatients who previously used NordiLet/other devices and had used another GH device (n=94). Age range 4 to ≤18 yearsThree-part survey to access GH device preference and ease of use, self-efficacy, positive feeling about injection and minimal disruption to daily life
  • Usability, minimal disruption to daily life and self-efficacy

  • Ease of use

  • Tolerability of injection

  • Impact on daily life

  • Patient/caregiver agency

Factors driving patient preferences for GHD injection regimen and injection device features24USAChild, adolescent and adult patients with a clinically confirmed diagnosis of GHD (n=224). Age range: paediatric 3–17 years (and caregivers) and adults (>25 years)Evaluation of factors driving preferences for r-hGH injection regimen and device features via DCE administered online questionnaire
  • Device characteristics (autoinjector), ease of preparation and injection schedule

  • Ease of use

  • Impact on daily life

Preferred features of GH injection devices25SwitzerlandParents who had children (1–18 years) without GHD (n=192). Average age of respondents was 40.2 yearsClosed-design, web-based questionnaire measuring preferences and willingness to pay for specific attribute
  • Storage and preparation convenience, device features and improved parent confidence

  • Ease of use

  • Tolerability of injection

  • Patient/caregiver agency

Preferred attributes of r-hGH administration28France, Germany, Italy, UK and USAIndividuals with experience in r-hGH administration (parents (with children <14 years old), teenage patients (13–15 years old) and physicians and nurses) (n=67)Through a questionnaire, 19 attributes were assessed to evaluate the importance of ergonomics, functionality and the psychological impact of device
  • Reliability, ease of use, lack of pain, safety, storage requirements and number of steps in preparation prior to use

  • Ease of use

Attitudes towards a reusable self-injection system (SurePal)
29
France, Germany and the UKPaediatric patients with GH deficiency, turner syndrome (TS), small gestational age, Prader-Willi syndrome, chronic renal failure (n=550). Mean age 10.8 yearsQuestionnaire measured attitudes on, attractiveness of device, training received, the low drug-wastage system and experience compared with other devices
  • Ease of preparation and administration

  • Ease of use

  • Impact on daily life

Needle-free device for GH
31
USAChildren (aged 4–10 years) with type 1 diabetes mellitus (n=50)A survey compared characteristics of a needle-free device to subjects morning insulin needle injection
  • Pan, easier preparation and administration

  • Ease of use

  • DCE, discrete choice experiment; GHD, growth hormone deficiency; GHT, growth hormone treatment; r-hGH, recombinant human growth hormone.