Endocrine Abstracts

Introduction

Acromegaly is a chronic disease associated with multiple comorbidities and increased incidence of cancer and mortality. The diagnosis often takes several years after the onset of symptoms. The costs of acromegaly in Finland are not known. This study aimed to characterize the treatment patterns, healthcare resource utilization, and direct costs of acromegaly in Finland.

Methods

All adult (≥18 years of age) patients with first acromegaly (ICD-10: E22) diagnosis during 2010-2016 were identified from the electronic health records (EHR) of Helsinki and Tampere University Hospitals. The EHR data were complemented with data from the national Finnish patient registers. The study period was 2010-2019, which covered a two-year baseline period prior to, and a three-year follow-up period after the diagnosis of acromegaly.

Results

The cohort consisted of 63 newly diagnosed patients with acromegaly (37 male/26 female) with a mean age of 47.6 years. Altogether, 75% (30/40) of the patients with baseline information on tumor size, had a macroadenoma, and the median growth hormone (GH) and insulin-like growth factor-1 (IGF-1) values at diagnosis were 248% and 263% of the upper limit of normal (ULN), respectively. The most common comorbidities were hypertension (37%), sleep apnea (24%) and arthropathy (19%). The participants had on an average nine follow-up healthcare visits annually (range 1–21), approximately 2.8 months apart. Transsphenoidal surgery was the most common first-line treatment (75%). First-line pharmacotherapies were somatostatin analogues (12% as monotherapy, 3% in combination with surgery), and dopamine agonists (7% as monotherapy, 2% with surgery). IGF-1, GH, and prolactin levels decreased gradually after the treatment initiation. Of the patients with a minimum 12 months of follow-up, 48% (24/50) reached a GH level <2, 5 µg/l after 6 months of treatment initiation. The mean total annual cost was 10, 500€, of which 69% (7, 200€) were related to healthcare resource utilization and 31% (3, 300€) to pharmacotherapy. The healthcare resource utilization cost was highest during the first year after the diagnosis (12, 500€), while annual pharmacotherapy costs increased gradually after the diagnosis.

Conclusions

The baseline patient demographics are in line with previous data from France and Sweden. In Finland, a vast majority of patients undergo surgery as first-line treatment. Approximately two-thirds of the total costs were related to healthcare resource utilization and one-third to pharmacotherapy.