Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome

Abstract

[Abstract] Context. There is no uniform standard of care for acromegaly. Due to the high costs involved, steps must be taken to ensure the cost-effective delivery of treatment. Objective. Taking the results of an earlier meta-analysis as a starting point, this study aims to determine whether treatment with long-acting somatostatin analogue (SSA) prior to surgery improves the cost-effectiveness of the treatment of acromegaly. Methods. The results are presented as an Incremental Cost Effectiveness Ratio (ICER) immediately after surgery, for the following year and over the next four decades. The cure rates percentage (95% CI) for the three randomized prospective controlled trials were 44.4% (34.2–54.7) and 18.2% (10.1–26.3) for preoperative treated and untreated patients respectively. The cost of pharmacological treatments was based on the number of units prescribed, dose and length of treatment. Results. The mean (95% CI) ICER immediately after surgery was €17,548 (12,007–33,250). In terms of the postoperative SSA treatment, the ICER changes from positive to negative before two years after surgery. One decade after surgery the ICER per patient/year was €− 9973 (− 18,798; − 6752) for postoperative SSA treatment and €− 31,733 (− 59,812; − 21,483) in the case of postoperative pegvisomant treatment. Conclusions. In centres without optimal surgical results, preoperative treatment of GH-secreting pituitary macroadenomas with SSA not only shows a significant improvement in the surgical results, but is also highly cost-effective, with an ICER per patient/year one decade after surgery, of between €− 9973 (− 18,798; − 6752) and €− 31,733 (− 59,812; − 21,483) for SSA and pegvisomant respectively.