open access

Vol 70, No 1 (2019)
Review paper
Submitted: 2018-07-05
Accepted: 2018-09-05
Published online: 2019-02-22
Get Citation

The content of this article is also available in the following languages:
Polski

The real costs of acromegaly: analysis of different therapies [Rzeczywiste koszty akromegalii: analiza różnych terapii]

Michał Elbaum1, Łukasz Mizera1, Marek Bolanowski1
·
Pubmed: 30843180
·
Endokrynol Pol 2019;70(1):74-85.
Affiliations
  1. Deptartment of Endocrinology, Diabetes and Isotope Therapy, Medical University Wroclaw, Wroclaw, Poland

open access

Vol 70, No 1 (2019)
Review Article
Submitted: 2018-07-05
Accepted: 2018-09-05
Published online: 2019-02-22

Abstract

Acromegaly is a rare, chronic condition caused by growth hormone (GH) overproduction, usually due to a benign tumour of the pituitary gland. During the disease many complications occur, including cardiovascular disease and changes in the musculoskeletal, respiratory, and endocrine systems. Treatment includes surgery, medical therapy, and radiation. In this paper a literature review was conducted for information related to costs of management of acromegaly and its associated comorbidities using PubMed.The majority of total costs represent pharmacological treatment, especially the most common somatostatin analogues (SSA) therapy. The average reported annual cost of SSA therapy is EUR 12,000–40,000. Surgery reduces the cost of care via the possibility of avoiding lifelong pharmacological treatment. Radiotherapy is also suggested to lower the costs of therapy because about 60% of patients eventually will not require further pharmacological treatment; however, it is connected with negative outcomes like hypopituitarism, lower quality of life, and increased mortality. Cabergoline and pegvisomant are the lowest and highest priced treatments, respectively, but the overall impact on the cost of therapy is minor due to less frequent usage of these drugs. It is hard to fully estimate the impact of comorbidities of acromegaly on financial burden because patients are treated for them many years before the diagnosis of the underlying pathology. The treatment cost of comorbidities is higher in uncontrolled patients. Life-long treatment of acromegaly and its comorbidities is very expensive. Early diagnosis and successful treatment reduce direct and indirect costs. 

Abstract

Acromegaly is a rare, chronic condition caused by growth hormone (GH) overproduction, usually due to a benign tumour of the pituitary gland. During the disease many complications occur, including cardiovascular disease and changes in the musculoskeletal, respiratory, and endocrine systems. Treatment includes surgery, medical therapy, and radiation. In this paper a literature review was conducted for information related to costs of management of acromegaly and its associated comorbidities using PubMed.The majority of total costs represent pharmacological treatment, especially the most common somatostatin analogues (SSA) therapy. The average reported annual cost of SSA therapy is EUR 12,000–40,000. Surgery reduces the cost of care via the possibility of avoiding lifelong pharmacological treatment. Radiotherapy is also suggested to lower the costs of therapy because about 60% of patients eventually will not require further pharmacological treatment; however, it is connected with negative outcomes like hypopituitarism, lower quality of life, and increased mortality. Cabergoline and pegvisomant are the lowest and highest priced treatments, respectively, but the overall impact on the cost of therapy is minor due to less frequent usage of these drugs. It is hard to fully estimate the impact of comorbidities of acromegaly on financial burden because patients are treated for them many years before the diagnosis of the underlying pathology. The treatment cost of comorbidities is higher in uncontrolled patients. Life-long treatment of acromegaly and its comorbidities is very expensive. Early diagnosis and successful treatment reduce direct and indirect costs. 
Get Citation

Keywords

acromegaly; therapy; costs; pharmacoeconomics

About this article
Title

The real costs of acromegaly: analysis of different therapies [Rzeczywiste koszty akromegalii: analiza różnych terapii]

Journal

Endokrynologia Polska

Issue

Vol 70, No 1 (2019)

Article type

Review paper

Pages

74-85

Published online

2019-02-22

Page views

3809

Article views/downloads

4464

DOI

10.5603/EP.a2018.0080

Pubmed

30843180

Bibliographic record

Endokrynol Pol 2019;70(1):74-85.

Keywords

acromegaly
therapy
costs
pharmacoeconomics

Authors

Michał Elbaum
Łukasz Mizera
Marek Bolanowski

References (45)
  1. Chanson P, Salenave S, Kamenicky P, et al. Pituitary tumours: Acromegaly. Best Pract Res Clin Endocrinol Metab. 2009; 23(5): 555–574.
  2. Daly AF, Rixhon M, Adam C, et al. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006; 91(12): 4769–4775.
  3. Bolanowski M, Ruchała M, Zgliczyński W, et al. Acromegaly — a novel view of the patient. Polish proposals for diagnostic and therapeutic procedures in the light of recent reports. Endokrynol Pol. 2014; 65(4): 326–331.
  4. Fernandez A, Karavitaki N, Wass JAH. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010; 72(3): 377–382.
  5. Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary. 1999; 2(1): 29–41.
  6. Reid TJ, Post KD, Bruce JN, et al. Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under-recognized and under-diagnosed. Clin Endocrinol (Oxf). 2010; 72(2): 203–208.
  7. Lesén E, Granfeldt D, Houchard A, et al. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur J Endocrinol. 2017; 176(2): 203–212.
  8. Didoni G, Grottol S, Gasco V, et al. Cost-of-illness study in acromegalic patients in Italy. J Endocrinol Invest. 2004; 27(11): 1034–1039.
  9. Roset M, Merino-Montero S, Luque-Ramírez M, et al. Cost of clinical management of acromegaly in Spain. Clin Drug Investig. 2012; 32(4): 235–245.
  10. Orlewska E, Kos-Kudla B, Sowinski J, et al. Dosage and costs of lanreotide Autogel 120 mg administered as part of routine acromegaly care in Poland - two years of data from Lanro-Study. Endokrynol Pol. 2015; 66(2): 142–148.
  11. Katznelson L, Laws ER, Melmed S, et al. Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99(11): 3933–3951.
  12. Karavitaki N, Turner HE, Adams CBT, et al. Surgical debulking of pituitary macroadenomas causing acromegaly improves control by lanreotide. Clin Endocrinol (Oxf). 2008; 68(6): 970–975.
  13. Luque-Ramírez M, Paramo C, Varela da Costa C, et al. Cost of management of invasive growth hormone-secreting macroadenoma. J Endocrinol Invest. 2007; 30(7): 541–545.
  14. Biermasz NR, Roelfsema F, Pereira AM, et al. Cost-effectiveness of lanreotide Autogel in treatment algorithms of acromegaly. Expert Rev Pharmacoecon Outcomes Res. 2009; 9(3): 223–234.
  15. Knutzen R, Ezzat S. The cost of medical care for the acromegalic patient. Neuroendocrinology. 2006; 83(3-4): 139–144.
  16. Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol. 2012; 2012: 540398.
  17. Zarządzenie Prezesa Narodowego Funduszu Zdrowia z dnia 30 grudnia 2016 r. w sprawie określenia warunków zawierania i realizacji umów w rodzaju leczenia szpitalnego. http://nfz gov pl/zarzadzenia-prezesa/zarzadzenia-prezesa-nfz/zarzadzenie-nr-1292016dsoz.
  18. Marko NF, LaSota E, Hamrahian AH, et al. Comparative effectiveness review of treatment options for pituitary microadenomas in acromegaly. J Neurosurg. 2012; 117(3): 522–538.
  19. Murray RD, Melmed S. A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly. J Clin Endocrinol Metab. 2008; 93(8): 2957–2968.
  20. Geraedts VJ, Andela CD, Stalla GK, et al. Predictors of Quality of Life in Acromegaly: No Consensus on Biochemical Parameters. Front Endocrinol (Lausanne). 2017; 8: 40.
  21. Margusino-Framiñán L, Pertega-Diaz S, Pena-Bello L, et al. Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome. Eur J Intern Med. 2015; 26(9): 736–741.
  22. Neggers SJ, Pronin V, Balcere I, et al. Lanreotide Autogel 120 mg at extended dosing intervals in patients with acromegaly biochemically controlled with octreotide LAR: the LEAD study. Eur J Endocrinol. 2015; 173(3): 313–323.
  23. Turner HE, Thornton-Jones VA, Wass JAH. Systematic dose-extension of octreotide LAR: the importance of individual tailoring of treatment in patients with acromegaly. Clin Endocrinol (Oxf). 2004; 61(2): 224–231.
  24. Bevan JS, Newell-Price J, Wass JAH, et al. Home administration of lanreotide Autogel by patients with acromegaly, or their partners, is safe and effective. Clin Endocrinol (Oxf). 2008; 68(3): 343–349.
  25. Johanson V, Wilson B, Abrahamsson A, et al. Randomized crossover study in patients with neuroendocrine tumors to assess patient preference for lanreotide autogel(®) given by either self/partner or a health care professional. Patient Prefer Adherence. 2012; 6: 703–710.
  26. Brue T, Castinetti F, Lundgren F, et al. ACROSTUDY investigators. Which patients with acromegaly are treated with pegvisomant? An overview of methodology and baseline data in ACROSTUDY. Eur J Endocrinol. 2009; 161 Suppl 1: S11–S17.
  27. Trainer PJ, Drake WM, Katznelson L, et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000; 342(16): 1171–1177.
  28. Zhang JJ, Nellesen D, Ludlam WH, et al. Budget impact of pasireotide LAR for the treatment of acromegaly, a rare endocrine disorder. J Med Econ. 2016; 19(4): 374–385.
  29. Jehle S, Reyes CM, Sundeen RE, et al. Alternate-day administration of pegvisomant maintains normal serum insulin-like growth factor-I levels in patients with acromegaly. J Clin Endocrinol Metab. 2005; 90(3): 1588–1593.
  30. Melmed S, Colao A, Barkan A, et al. Acromegaly Consensus Group. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009; 94(5): 1509–1517.
  31. Lee SY, Kim JH, Lee JiH, et al. The efficacy of medical treatment in patients with acromegaly in clinical practice. Endocr J. 2018; 65(1): 33–41.
  32. Kimmell KT, Weil RJ, Marko NF. Multi-modal management of acromegaly: a value perspective. Pituitary. 2015; 18(5): 658–665.
  33. Castinetti F, Morange I, Dufour H, et al. Radiotherapy and radiosurgery in acromegaly. Pituitary. 2009; 12(1): 3–10.
  34. Gheorghiu ML. Updates in outcomes of stereotactic radiation therapy in acromegaly. Pituitary. 2017; 20(1): 154–168.
  35. Ritvonen E, Löyttyniemi E, Jaatinen P, et al. Mortality in acromegaly: a 20-year follow-up study. Endocr Relat Cancer. 2016; 23(6): 469–480.
  36. Bolin K, Gip C, Mörk AC, et al. Diabetes, healthcare cost and loss of productivity in Sweden 1987 and 2005 — a register-based approach. Diabet Med. 2009; 26(9): 928–934.
  37. Ericson L, Bergfeldt L, Björholt I. Atrial fibrillation: the cost of illness in Sweden. Eur J Health Econ. 2011; 12(5): 479–487.
  38. Jansson SA, Rönmark E, Forsberg B, et al. The economic consequences of asthma among adults in Sweden. Respir Med. 2007; 101(11): 2263–2270.
  39. Lundqvist A, Andersson E, Steen Carlsson K. Costs of cancer in Sweden today and year 2040. Report in Swedish. IHE Rapport 2016: 1. https://ihe.se/publicering/kostnad-for-cancer/.
  40. Placzek H, Xu Y, Mu Y, et al. Clinical and Economic Burden of Commercially Insured Patients with Acromegaly in the United States: A Retrospective Analysis. J Manag Care Spec Pharm. 2015; 21(12): 1106–1112.
  41. Swearingen B, Wu N, Chen SY, et al. Health care resource use and costs among patients with cushing disease. Endocr Pract. 2011; 17(5): 681–690.
  42. Broder MS, Neary MP, Chang E, et al. Incremental healthcare resource utilization and costs in US patients with Cushing's disease compared with diabetes mellitus and population controls. Pituitary. 2015; 18(6): 796–802.
  43. Broder MS, Neary MP, Chang E, et al. Burden of illness, annual healthcare utilization, and costs associated with commercially insured patients with Cushing disease in the United States. Endocr Pract. 2015; 21(1): 77–86.
  44. Zygourakis CC, Imber BS, Chen R, et al. Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas. J Neurol Surg B Skull Base. 2017; 78(2): 125–131.
  45. Ben-Shlomo A, Sheppard MC, Stephens JM, et al. Clinical, quality of life, and economic value of acromegaly disease control. Pituitary. 2011; 14(3): 284–294.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaWydawcą jest  VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl