Longitudinal assessment of economic burden and clinical outcomes in acromegaly

To determine costs and outcomes over time for surgical and various medical regimens in the management of patients with acromegaly.

We studied a sample of 53 consecutive Canadian patients with acromegaly who underwent a transsphenoidal pituitary surgical procedure only (N = 27) or in conjunction with medical therapy (N = 26). Outcomes were analyzed as person-months spent in various health state outcomes, which were defined on the basis of growth hormone and insulin-like growth factor I levels. Costs are reported in 1998 Canadian dollars.

The mean duration of follow-up was 49 months. Of the 53 patients, 25 (47%) had microadenomas at admission. Patients spent as much as 65% of the time in "uncured" health states. Patients with less extensive disease had better outcomes. The mean annual cost per patient was $8,111 (95% confidence interval, $5,848 to $10,374). Medications were the largest contributor to overall cost (38%). Although per patient surgical costs themselves were high (ranging from approximately $2,800 to $9,200), when averaged over the 4 years the mean annual cost was approximately $2,400, less than the cost of medications. Treatment of macroadenomas cost more than treatment of microadenomas ($11,425 versus $4,442 annually). The treatment of acromegaly costs $14.7 million annually in Canada (95% confidence interval, $10.6 to $18.8 million) and, if patterns of care are similar, about $139 million annually in the United States.

Treatment of acromegaly is no more costly than therapy for other chronic diseases, especially those with a surgical component. Early diagnosis (at the stage of microadenoma) resulted in better outcomes and lower costs. Thus, from the standpoint of economics and well-being, a continued aggressive attitude toward screening programs and treatment of persistently active acromegaly seems warranted.