Economics of Acromegaly Treatment in Brazil: A Budget Impact Analysis of Pituitary Surgery Compared with Long-Term Octreotide LAR

Abstract

Background Acromegaly is a rare, chronic and debilitating disease whose treatment places a high burden on health systems. In the reality of the Brazilian public health network, many patients are kept on drug treatment because of barriers to access to surgery. Objective The aim of this study was to estimate the costs and budget impact of routine transsphenoidal endoscopic surgery in relation to those of long-term drug treatment with octreotide long-acting release (LAR) from a cohort of patients followed at the referral medical centre for acromegaly treatment in the Federal District, Brazil. Methods Based on micro-costing data collected using mixed methods from a local perspective of the public health system, we performed a budget impact analysis (BIA) on a 3-year time horizon. Uncertainty was handled with deterministic (tornado and scenario) and probabilistic (Monte Carlo simulations) sensitivity analyses. Results Compared with the continued use of octreotide LAR at a dose of 30 mg every 28 days, the incremental budget impact of conducting two surgeries per month, considering a cure rate of 55%, could bring savings of approximately US$879,362.18 (95% CI 860,176.29–898,548.08) over 3 years. Depending on the key variable values, the savings amplitude ranged from US$431,836.39 to US$1,519,132.04. Conclusions Improving access to surgery could result in significant cost reductions in acromegaly treatment. The present study stands out for being the first to estimate the costs of transsphenoidal surgery in the context of the public health system in Brazil. Electronic supplementary material The online version of this article (10.1007/s41669-018-0103-2) contains supplementary material, which is available to authorized users.

Implementation and Monitoring of a Telemedicine Model in Acromegalic Outpatients in a Low-Income Country During the COVID-19 Pandemic

“…Considering the exceptionality conferred by the pandemic, telemedicine became the only accessible option to maintain adequate medical assistance. That being said, the adherence in the study group was similar to that observed in face-to-face consultations carried out in previous years [13][14][15] and the medical effectiveness of the remote medical assistance seemed to be comparable to the conventional protocol in our service.…”

“…The estimated high costs of pharmacological therapy demand a robust social protection system to prevent inequity in access to medicines. 13 To have access to a supply of drugs, the patient needs to accomplish several steps: (1) have a medical evaluation; (2) obtain the printed prescription; (3) take it to the central highcost public pharmacy; and (4) receive the medicine and bring it back to the hospital to receive the injection.…”

“…These results were comparable to adherence observed in conventional face-to-face consultations over the last 10 years, as previously published by our group. [13][14][15] In the survey applied after the second virtual visit, 52.4% of patients reported the desire to schedule a face-to-face consultation within the next 3 months.…”

Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care

“…Related to this is whether these LoC patterns differ from that of the general population. Studying utilization of LoC is essential for efficient resource allocation and healthcare funding, [20,21], especially as the costs of treating acromegaly can A c c e p t e d M a n u s c r i p t be exorbitant. [22] The main objective of this analysis was to evaluate the likelihood, number, and cost of healthcare services used, according to LoC, by individuals with acromegaly and a matched control group.…”