Cost of management of invasive growth hormone-secreting macroadenoma

Abstract

Background: At the time of diagnosis, macroadenomas represent 60–80% of GH secreting adenomas, of which 25–30% are invasive macroadenomas. These aggressive tumors have the worst surgical success rates in terms of cure, and often need several therapeutic approaches in order to control disease status. Acromegalic patients are subject to increased mortality and important health resource consumption related to their associated co-morbidities, in addition to the costs that are related to diagnosis itself and initial treatment of the disease. Objective: Assessment of the cost of initial management and outcome of acromegalic patients with invasive pituitary adenomas. Study design: Retrospective and observational study of review of records. Setting: Two tertiary hospitals. Patients: 11 consecutive patients between 18 and 80 yr old diagnosed with acromegaly due to an invasive pituitary macroadenoma. Intervention: Collection of data of biochemical and radiological tests, specialist visits, hospitalisation, surgery, pharmacological and radiotherapy treatment at diagnosis and over 4 yr of follow-up after initial treatment. Costs were evaluated using the data of the Centre for Health Economics and Social Policy Studies and the Official College of Pharmacists of Spain. Main outcome measure: Global and patient/yr follow-up costs of illness. Results: The mean costs for acromegaly for the period of follow-up ranged from 7,072 to 9,874 €/patient/yr, for biochemically non-controlled (no.=6) and controlled patients (no.=5) respectively. The most important cost in the perioperative period was for admission in the intensive care unit. After surgery, SS analogues were the principal contributors to the economic burden. Conclusion: In this paper we have for the first time presented a pharmacoeconomic study of GH secreting invasive macroadenoma. The poor prognosis of our cohort of patients and the higher rate of controlled patients and normal IGF-I levels warrant the employment of multiple therapeutic options. The cost associated with this treatment in this complex disease of low prevalence is not excessive and can be supported by healthcare services.