Treatments, complications, and healthcare utilization associated with acromegaly: a study in two large United States databases

Abstract

The economic burden of acromegaly in the US has been largely unknown. We describe the prevalence of treatment patterns, complication rates, and associated healthcare utilization and costs of acromegaly in the US. Patients were identified between 1/1/2002 and 12/31/2009 in claims databases. During 1-year after each continuously-enrolled patient's first acromegaly claim, pharmacy and medical claims were used to estimate outcomes. Regression models were used to adjust outcomes. There were 2,171 acromegaly patients (mean age: 45.3 years; 49.7% female); 77.8% received the majority of their care from non-endocrinologists. Pharmacologic treatment was used by 30.8% of patients: octreotide-LAR in 18.6%, dopamine agonists in 9.8%, short-acting octreotide in 4.7%, pegvisomant in 4.1%, and lanreotide in 1.2%; 56% had biochemical monitoring. Comorbidities were common, ranging from 6.6% (colon neoplasms) to 25.6% (musculoskeletal abnormalities). Mean healthcare costs were $24,900. Adjusted analyses indicated comorbidities increased the odds of hospitalization: by 76% for musculoskeletal abnormalities; 193% for cardiovascular abnormalities; and 56% for sleep apnea (p< 0.05). Odds of emergency department visits increased by 87% (musculoskeletal) and 132% (cardiovascular abnormalities) (p < 0.01). After adjustments, colon neoplasms were associated with $8,401 mean increase in costs; musculoskeletal abnormalities with $7,502, cardiovascular abnormalities with $13,331, sleep apnea with $10,453, and hypopituitarism with $6,742 (p < 0.01). Complications are common and increase utilization and cost in acromegaly patients. Cardiovascular complications nearly tripled the odds of hospitalization (OR 2.93) and increased annual mean cost by $13,331. Adequate management of this disease may be able to reduce health care utilization and cost associated with these complications and with acromegaly in general.

Wpływ cukrzycy na przeżycie pacjentów z akromegalią

“…The mean age of our cohort was younger than that in most previous reports [5,6,16,17]. The disease activity of GH-producing tumours in patients with acromegaly has been suggested to be associated with visceral adiposity index and insulin sensitivity [18,19]; however, IGF-I correlates more closely than GH with insulin resistance and glucose intolerance [20,21].…”

Communication practices and awareness of resources for acromegaly patients among endocrinologists

“…In this study, the majority (70%) of patients were currently on treatment, and the vast majority (>90%) of those patients were prescribed SSAs or pegvisomant. Recent claims database studies have also reported SSAs and pegvisomant (collectively) among the most common treatments 8,20,21. All of these treatments are injectable therapies, which can be associated with various patient concerns18 and difficulties in terms of side effects, adherence, and overall impact on QoL;4 these treatments are also associated with substantial costs 7,8.…”

“…Symptoms of acromegaly, which commonly include fatigue, joint pain, snoring, excessive sweating, and headaches, often interfere with daily life activities 1,4. Acromegaly-related comorbidities and complications (eg, cardiovascular disease, diabetes, cancer, kidney failure, hypothyroidism, bone/joint abnormalities, and sleep apnea)1,5–9 further contribute to decreased QoL10 and are associated with a high economic burden7,8 and increased mortality risk 11,12…”

Patient-Centered Assessment on Disease Burden, Quality of Life, and Treatment Satisfaction Associated with Acromegaly

“…Therefore, the disease burden and cost of acromegaly treatment emerge as a considerable topic for acromegaly management. The direct healthcare cost was $24,900 during the first 12 months of follow-up period following diagnosis of acromegaly reported in a cross-sectional cohort study in the USA 3. Very few studies have assessed the impact on the disease burden of acromegaly, especially on treatment satisfaction and indirect costs such as work productivity/employment in the USA.…”