Endocrine Abstracts

Acromegaly and comorbidities incur large costs in the Swedish health care system. The aim of the study was to describe direct costs since time of diagnosis, for patients with acromegaly due to a pituitary tumour in Sweden. Data were obtained via linkage of nationwide registers. Patients diagnosed between 1 July 2005 and 31 December 2007 in Sweden and with a follow-up of at least 6 years were included (n=105). Direct costs due to use of health care resources and pharmacological treatments (somatostatin analogues [SSA], growth hormone receptor antagonists [GHRA], and dopamine agonists [DA]) were assessed. The mean total direct costs per patient were highest for year 1 after diagnosis (€18 108 [95%CI 15 952–20 265]) with surgical interventions being the main contributor (54%). For subsequent years, the mean (95%CI) costs ranged from a maximum of €8,770 (6733–10 807) (year 2) to a minimum of €6686 (4943–8429) (year 4), with acromegaly drug costs as the largest part. The share of direct costs due to acromegaly amounted to 95% (remaining 5% due to comorbidities) for the first year after diagnosis and fell to 86% (comorbidities 14%) during year 6. SSAs (lanreotide and octreotide) were the main contributors to drug costs (>86% throughout the study period). Costs for drugs for the treatment of acromegaly increased every year and rose from 15% during year 1 to 77% for year 6 with GHRA (47%), lanreotide (44%), and octreotide (9%) costs as contributors. DA costs decreased over time but were overall negligible. Over the follow-up period, the number of patients treated with lanreotide rose from 12 (11%) to 20 (19%) patients while corresponding numbers for octreotide fell from 26 (25%) to 13 (12%) patients. During year 1 and 2, no patients were treated with GHRA but this increased to eight (8%) patients during year 6. When the mean direct costs per patient using each drug were analysed, lanreotide costs increased 31% from year 1 to year 6. The corresponding increase for octreotide was 135% while the increase from year 3 to 6 for GHRA (pegvisomant) was 186%. Real world evidence from national registers allows detailed monitoring of changes in direct costs after diagnosis of acromegaly. Surgical interventions are a main contributor (54%) to the total direct costs during the first year after diagnosis, but pharmaceutical treatments become more important over time with SSA and, to some extent, GHRA as the main contributors.