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Evaluation of acromegaly treatment direct costs with respect to biochemical control and follow-up length

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Abstract

Purpose

Acromegaly is a severe chronic endocrine disease. Achieving biochemical control often needs a multimodal treatment approach, including prolonged medical treatment. Aim of the study is to evaluate the burden of treatment direct costs with respect to the different therapeutic strategies, disease control, and follow-up length.

Methods

Single center retrospective study on 73 acromegaly patients. Costs of acromegaly treatments were computed based on a detailed revision of patients’ clinical charts.

Results

Median total treatment cost/patient was €47,343 during the entire follow-up (8 years), while median treatment cost/patient/year was €6811. The majority of patients received medical therapy (71/73, 97.3%). Median cost for first-line medical treatment (first-generation somatostatin receptor ligands) was lower compared to second-line treatments (pegvisomant monotherapy or combination therapies), considering both total (€22,824 vs €76,140; p < 0.001), and yearly cost/patient (€4927 vs €9161; p < 0.001). Sixty patients (82.2%) reached biochemical control at last follow-up (IGF-1 ≤ 1 xULN). The percentage of patients treated with first- or second-line medical therapies was comparable between controlled and uncontrolled patients (p = 1.000), and the yearly cost/patient did not significantly differ between the two groups (€6936 vs €6680; p = 0.829). Follow-up duration was significantly longer in controlled patients compared to the uncontrolled ones (8.7 vs 3.5 years; p = 0.019).

Conclusions

Direct costs for the management of acromegaly have a significant burden on the healthcare systems. However, more than 80% of our patients reached biochemical control using multimodal approaches. Treatment modalities and yearly costs did not significantly differ between controlled and uncontrolled patients, while follow-up length represented a major determinant of biochemical outcome.

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References

  1. Melmed S (2009) Acromegaly pathogenesis and treatment. J Clin Invest. https://doi.org/10.1172/JCI39375

    Article  PubMed  PubMed Central  Google Scholar 

  2. Burton T, Le Nestour E, Neary M, Ludlam WH (2016) Incidence and prevalence of acromegaly in a large US health plan database. Pituitary. https://doi.org/10.1007/s11102-015-0701-2

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dal J, Feldt-Rasmussen U, Andersen M, Kristensen LO, Laurberg P, Pedersen L, Dekkers OM, Sorensen HT, Jorgensen JO (2016) Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. Eur J Endocrinol. https://doi.org/10.1530/EJE-16-0117

    Article  PubMed  Google Scholar 

  4. Gatto F, Trifiro G, Lapi F, Cocchiara F, Campana C, Dell’Aquila C, Ferrajolo C, Arvigo M, Cricelli C, Giusti M, Ferone D (2018) Epidemiology of acromegaly in Italy: analysis from a large longitudinal primary care database. Endocrine. https://doi.org/10.1007/s12020-018-1630-4

    Article  PubMed  Google Scholar 

  5. Caputo M, Ucciero A, Mele C, De Marchi L, Magnani C, Cena T, Marzullo P, Barone-Adesi F, Aimaretti G (2019) Use of administrative health databases to estimate incidence and prevalence of acromegaly in Piedmont Region. Italy J Endocrinol Invest. https://doi.org/10.1007/s40618-018-0928-7

    Article  PubMed  Google Scholar 

  6. Crisafulli S, Luxi N, Sultana J, Fontana A, Spagnolo F, Giuffrida G, Ferrau F, Gianfrilli D, Cozzolino A, Cristina De Martino M, Gatto F, Barone-Adesi F, Cannavo S, Trifiro G (2021) Global epidemiology of acromegaly: a systematic review and meta-analysis. Eur J Endocrinol. https://doi.org/10.1530/EJE-21-0216

    Article  PubMed  Google Scholar 

  7. Ben-Shlomo A, Melmed S (2008) Acromegaly. Endocrinol Metab Clin N Am. https://doi.org/10.1016/j.ecl.2007.10.002

    Article  Google Scholar 

  8. Pivonello R, Auriemma RS, Grasso LF, Pivonello C, Simeoli C, Patalano R, Galdiero M, Colao A (2017) Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary. https://doi.org/10.1007/s11102-017-0797-7

    Article  PubMed  Google Scholar 

  9. Gatto F, Campana C, Cocchiara F, Corica G, Albertelli M, Boschetti M, Zona G, Criminelli D, Giusti M, Ferone D (2019) Current perspectives on the impact of clinical disease and biochemical control on comorbidities and quality of life in acromegaly. Rev Endocr Metab Disord. https://doi.org/10.1007/s11154-019-09506-y

    Article  PubMed  Google Scholar 

  10. Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, Wass JA, Endocrine S (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2014-2700

    Article  PubMed  PubMed Central  Google Scholar 

  11. Colao A, Auriemma RS, Pivonello R (2016) The effects of somatostatin analogue therapy on pituitary tumor volume in patients with acromegaly. Pituitary. https://doi.org/10.1007/s11102-015-0677-y

    Article  PubMed  Google Scholar 

  12. Melmed S, Bronstein MD, Chanson P, Klibanski A, Casanueva FF, Wass JAH, Strasburger CJ, Luger A, Clemmons DR, Giustina A (2018) A consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. https://doi.org/10.1038/s41574-018-0058-5

    Article  PubMed  PubMed Central  Google Scholar 

  13. Giustina A, Chanson P, Kleinberg D, Bronstein MD, Clemmons DR, Klibanski A, van der Lely AJ, Strasburger CJ, Lamberts SW, Ho KK, Casanueva FF, Melmed S, Acromegaly Consensus G (2014) Expert consensus document: a consensus on the medical treatment of acromegaly. Nat Rev Endocrinol. https://doi.org/10.1038/nrendo.2014.21

    Article  PubMed  Google Scholar 

  14. Bonert V, Mirocha J, Carmichael J, Yuen KCJ, Araki T, Melmed S (2020) Cost-effectiveness and efficacy of a novel combination regimen in acromegaly: a prospective, randomized trial. J Clin Endocrinol Metab. https://doi.org/10.1210/clinem/dgaa444

    Article  PubMed  PubMed Central  Google Scholar 

  15. Giustina A, Barkhoudarian G, Beckers A, Ben-Shlomo A, Biermasz N, Biller B, Boguszewski C, Bolanowski M, Bollerslev J, Bonert V, Bronstein MD, Buchfelder M, Casanueva F, Chanson P, Clemmons D, Fleseriu M, Formenti AM, Freda P, Gadelha M, Geer E, Gurnell M, Heaney AP, Ho KKY, Ioachimescu AG, Lamberts S, Laws E, Losa M, Maffei P, Mamelak A, Mercado M, Molitch M, Mortini P, Pereira AM, Petersenn S, Post K, Puig-Domingo M, Salvatori R, Samson SL, Shimon I, Strasburger C, Swearingen B, Trainer P, Vance ML, Wass J, Wierman ME, Yuen KCJ, Zatelli MC, Melmed S (2020) Multidisciplinary management of acromegaly: a consensus. Rev Endocr Metab Disord. https://doi.org/10.1007/s11154-020-09588-z

    Article  PubMed  PubMed Central  Google Scholar 

  16. Elbaum M, Mizera L, Bolanowski M (2019) The real costs of acromegaly: analysis of different therapies. Endokrynol Pol. https://doi.org/10.5603/EP.a2018.0080

    Article  PubMed  Google Scholar 

  17. Biermasz NR, Roelfsema F, Pereira AM, Romijn JA (2009) Cost-effectiveness of lanreotide Autogel in treatment algorithms of acromegaly. Expert Rev Pharmacoecon Outcomes Res. https://doi.org/10.1586/erp.09.17

    Article  PubMed  Google Scholar 

  18. Lesen E, Granfeldt D, Houchard A, Dinet J, Berthon A, Olsson DS, Bjorholt I, Johannsson G (2017) Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur J Endocrinol. https://doi.org/10.1530/EJE-16-0623

    Article  PubMed  Google Scholar 

  19. Maione L, Chanson P (2019) National acromegaly registries. Best Pract Res Clin Endocrinol Metab. https://doi.org/10.1016/j.beem.2019.02.001

    Article  PubMed  Google Scholar 

  20. Campana C, Cocchiara F, Corica G, Nista F, Arvigo M, Amaru J, Rossi DC, Zona G, Ferone D, Gatto F (2020) Discordant GH and IGF-1 results in treated acromegaly: impact of GH cut-offs and mean values assessment. J Clin Endocrinol Metab. https://doi.org/10.1210/clinem/dgaa859

    Article  PubMed  Google Scholar 

  21. van Esdonk MJ, van Zutphen EJM, Roelfsema F, Pereira AM, van der Graaf PH, Biermasz NR, Stevens J, Burggraaf J (2018) How are growth hormone and insulin-like growth factor-1 reported as markers for drug effectiveness in clinical acromegaly research? A comprehensive methodologic review. Pituitary. https://doi.org/10.1007/s11102-018-0884-4

    Article  PubMed  PubMed Central  Google Scholar 

  22. van der Lely AJ, Gomez R, Pleil A, Badia X, Brue T, Buchfelder M, Burman P, Clemmons D, Ghigo E, Jorgensen JOL, Luger A, van der Lans-Bussemaker J, Webb SM, Strasburger CJ (2017) Development of ACRODAT((R)), a new software medical device to assess disease activity in patients with acromegaly. Pituitary. https://doi.org/10.1007/s11102-017-0835-5

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nista F, Corica G, Castelletti L, Khorrami K, Campana C, Cocchiara F, Zoppoli G, Prior A, Rossi DC, Zona G, Ferone D, Gatto F (2021) Clinical and radiological predictors of biochemical response to first-line treatment with somatostatin receptor ligands in acromegaly: a real-life perspective. Front Endocrinol (Lausanne). https://doi.org/10.3389/fendo.2021.677919

    Article  Google Scholar 

  24. Sesmilo G (2013) Epidemiology of acromegaly in Spain. Endocrinol Nutr. https://doi.org/10.1016/j.endonu.2012.09.010

    Article  PubMed  Google Scholar 

  25. Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, Auriemma R, Diallo AM, Hulting AL, Ferone D, Hana V Jr, Filipponi S, Sievers C, Nogueira C, Fajardo-Montanana C, Carvalho D, Hana V, Stalla GK, Jaffrain-Rea ML, Delemer B, Colao A, Brue T, Neggers S, Zacharieva S, Chanson P, Beckers A (2017) Acromegaly at diagnosis in 3173 patients from the Liege Acromegaly Survey (LAS) Database. Endocr Relat Cancer. https://doi.org/10.1530/ERC-17-0253

    Article  PubMed  PubMed Central  Google Scholar 

  26. Didoni G, Grottol S, Gasco V, Battistini M, Ferone D, Giusti M, Ragazzoni F, Ruffo P, Ghigo E, Minuto F (2004) Cost-of-illness study in acromegalic patients in Italy. J Endocrinol Invest. https://doi.org/10.1007/BF03345306

    Article  PubMed  Google Scholar 

  27. Kasuki L, Wildemberg LE, Gadelha MR (2018) MANAGEMENT OF ENDOCRINE DISEASE: personalized medicine in the treatment of acromegaly. Eur J Endocrinol. https://doi.org/10.1530/EJE-17-1006

    Article  PubMed  Google Scholar 

  28. Giustina A, Arnaldi G, Bogazzi F, Cannavo S, Colao A, De Marinis L, De Menis E, Degli Uberti E, Giorgino F, Grottoli S, Lania AG, Maffei P, Pivonello R, Ghigo E (2017) Pegvisomant in acromegaly: an update. J Endocrinol Invest. https://doi.org/10.1007/s40618-017-0614-1

    Article  PubMed  PubMed Central  Google Scholar 

  29. Colao A, Lombardi G (2010) Dose optimization of somatostatin analogues for acromegaly patients. J Endocrinol Invest. https://doi.org/10.1007/BF03346566

    Article  PubMed  Google Scholar 

  30. Carmichael JD, Broder MS, Cherepanov D, Chang E, Mamelak A, Said Q, Neary MP, Bonert V (2017) Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center. BMC Endocr Disord. https://doi.org/10.1186/s12902-017-0199-x

    Article  PubMed  PubMed Central  Google Scholar 

  31. Maione L, Brue T, Beckers A, Delemer B, Petrossians P, Borson-Chazot F, Chabre O, Francois P, Bertherat J, Cortet-Rudelli C, Chanson P, French Acromegaly Registry Group (2017) Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry. Eur J Endocrinol. https://doi.org/10.1530/EJE-16-1064

    Article  PubMed  Google Scholar 

  32. Puig-Domingo M, Bernabeu I, Pico A, Biagetti B, Gil J, Alvarez-Escola C, Jorda M, Marques-Pamies M, Soldevila B, Galvez MA, Camara R, Aller J, Lamas C, Marazuela M (2021) Pasireotide in the personalized treatment of acromegaly. Front Endocrinol (Lausanne). https://doi.org/10.3389/fendo.2021.648411

    Article  Google Scholar 

  33. Pedraza-Arevalo S, Gahete MD, Alors-Perez E, Luque RM, Castano JP (2018) Multilayered heterogeneity as an intrinsic hallmark of neuroendocrine tumors. Rev Endocr Metab Disord. https://doi.org/10.1007/s11154-018-9465-0

    Article  PubMed  Google Scholar 

  34. Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS, Melmed S, Mortini P, Wass J, Giustina A, Pituitary Society, Expert Group on Pituitary Tumors (2017) Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement. Pituitary. https://doi.org/10.1007/s11102-017-0838-2

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gadelha MR (2015) A paradigm shift in the medical treatment of acromegaly: from a ‘trial and error’ to a personalized therapeutic decision-making process. Clin Endocrinol (Oxf). https://doi.org/10.1111/cen.12797

    Article  Google Scholar 

  36. Bonert V, Carmichael J, Wu Z, Mirocha J, Perez DA, Clarke NJ, Reitz RE, McPhaul MJ, Mamelak A (2018) Discordance between mass spectrometry and immunometric IGF-1 assay in pituitary disease: a prospective study. Pituitary. https://doi.org/10.1007/s11102-017-0849-z

    Article  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy

    Francesco Cocchiara, Claudia Campana, Federica Nista, Giuliana Corica, Angelo Milioto & Diego Ferone

  2. Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy

    Marco Ceraudo, Diego Criminelli Rossi & Gianluigi Zona

  3. Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy

    Francesco Cocchiara, Diego Ferone & Federico Gatto

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  1. Francesco Cocchiara
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  2. Claudia Campana
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  3. Federica Nista
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Correspondence to Federico Gatto.

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Cocchiara, F., Campana, C., Nista, F. et al. Evaluation of acromegaly treatment direct costs with respect to biochemical control and follow-up length. Pituitary 25, 246–257 (2022). https://doi.org/10.1007/s11102-021-01193-w

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