Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study

Lesén, Eva; Granfeldt, Daniel; Houchard, Aude; Dinet, Jérôme; Berthon, Anthony; Olsson, Daniel S; Björholt, Ingela; Johannsson, Gudmundur

doi:10.1530/eje-16-0623

Cited by 57 publications

(64 citation statements)

References 34 publications

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“…This sum consisted of direct costs in 77% of cases. The remaining part, and therefore a distinct minority, was indirect costs associated with the productivity loss due to sickness absence and mortality [7]. Similar annual direct costs were reported by the authors of other European studies from Italy and Spain -about EUR 8000-12,000 and EUR 10,000 per patient, respectively [8,9].…”

Section: Overall Direct and Indirect Costs Of Acromegaly Treatmentsupporting

confidence: 74%

“…There is a correspondence between studies assessing health care costs for acromegalic patients, that the vast majority of direct medical costs are caused by pharmacological treatment [7][8][9]. In the largest pub-…”

Section: Overall Direct and Indirect Costs Of Acromegaly Treatmentmentioning

confidence: 99%

“…lished research on this topic carried out by Lesén et al medication accounted for 2/3 of direct costs -twice as much as costs related to imaging, laboratory and ophthalmological assessment, stationary and outpatient specialist care, and surgical interventions taken together [7].…”

Section: Prace Poglądowementioning

confidence: 99%

“…In the study published by Lesén et al the annual cost of SSA therapy in Sweden in 2013 was estimated at EUR 13,500 [7]. In a paper of Orlewska et al the annual average cost of lanreotide Autogel 120 mg therapy in Poland was calculated at PLN 48,750 (EUR 12,187) [10].…”

Section: Somatostatin Analoguesmentioning

confidence: 99%

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The real costs of acromegaly: analysis of different therapies

Elbaum

Mizera

Bolanowski

2019

Endokrynologia Polska

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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. (Endokrynol Pol 2019; 70 (1): 74-79)

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Section: Overall Direct and Indirect Costs Of Acromegaly Treatmentsupporting

confidence: 74%

Section: Overall Direct and Indirect Costs Of Acromegaly Treatmentmentioning

confidence: 99%

Section: Prace Poglądowementioning

confidence: 99%

Section: Somatostatin Analoguesmentioning

confidence: 99%

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The real costs of acromegaly: analysis of different therapies

Elbaum

Mizera

Bolanowski

2019

Endokrynologia Polska

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“…Uncontrolled acromegaly is associated with increased mortality and several morbidities are commonly present, including IGT and T2DM, arterial hypertension, dyslipidemia, sleep apnea and malignancies (53,54). Currently, acromegaly is treated by a combination of surgery, radiotherapy and three classes of drugs: dopamine-agonists (cabergoline), somatostatin analogs (octreotide, lanreotide, pasireotide) and GHR antagonists (pegvisomant).…”

Section: Ghr Polymorphism In Acromegalymentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Clinical and pharmacogenetic aspects of the growth hormone receptor polymorphism

Boguszewski

Barbosa

Svensson

et al. 2017

European Journal of Endocrinology

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Pharmacogenetics aims to maximize the beneficial effects of a medical therapy by identifying genetic finger prints from responders and non-responders and, thereby improving safety and efficacy profile of the drug. Most subjects who are deficient in growth hormone (GHD) are candidates for recombinant human GH (rhGH) therapy. To date, it is well established that even after adjustments for several clinical variables, such as age, gender, body composition and the age at onset of the GHD, response to rhGH treatment is highly variable among individuals, part of which is believed to be due to genetic factors within the GH system. As the first genetic variant to potentially influence the individual response to rhGH therapy in children with growth disorders, polymorphism in the GH receptor (GHR) has attracted a great interest as a target for pharmacogenetics. Studies have been conducted to compare the functional and molecular effects of the full-length GHR (fl-GHR) isoform with the exon 3 deleted (d3-GHR) isoform in children and adults treated with rhGH therapy. Additionally, the impact of the GHR polymorphism has been investigated in relation to the clinical status and response to medical treatment in acromegaly, especially to the GHR antagonist drug pegvisomant. We have performed a narrative review of the studies performed to date on the association of GHR polymorphism with rhGH response in children and adults, and its potential influence in the medical management of acromegaly. In addition, data from studies on the general population and in other chronic diseases examining a role of this genetic variant in the regulation of growth and metabolism are summarized. The growth hormone receptor (GHR)Growth hormone (GH) exerts its biological effects by binding to the GH receptor (GHR). The GHR protein is positioned at the cell membrane of almost every cell in the human body and contains a 246 amino acids long extracellular (GH-binding) domain, a transmembrane domain and a 350 amino acids long intracellular (cytoplasmic) domain. In total, the GHR protein is composed of 638 residues (1). Binding of GH to the GHR induces a series of subtle conformational events within a receptor homodimer, rather than a simple receptor dimerization, promoting a realignment of the two receptors both by relative rotation and by closer apposition just above the cell membrane (2). The parallel receptor transmembrane domains are converted into a rotated crossover orientation and the lower parts of the transmembrane helices are separated. GHR activation

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