Cost–effectiveness of lanreotide Autogel^®in treatment algorithms of acromegaly

Abstract

The introduction of effective pharmacological treatments has changed the management of acromegaly. However, chronic, life-long treatment with somatostatin analogues and/or growth hormone receptor antagonists is very expensive. We estimated the costs of treatment algorithms to control acromegaly from a Dutch perspective. We used the following assumptions: after the diagnosis of acromegaly there is a mean remaining lifespan of approximately 33 years; the success rates of surgery and somatostatin analogues in controlling the disease are approximately 60%; and the lifelong costs of different algorithms to control acromegaly in 100 patients ranged from 43 million euros (primary surgery and secondary somatostatin analogues) to 57 million euros (primary somatostatin analogues and secondary surgery) and even reached 95 million euros (medical treatment only). In algorithms that include trans-sphenoidal surgery, the lifetime treatment costs are almost 46-59% cheaper per 100 patients than in algorithms with medical treatment but without trans-sphenoidal surgery. Algorithms with primary surgery and secondary somatostatin analogs are 30% cheaper per 100 patients than algorithms with primary somatostatin analogues and secondary surgery. Per 100 patients, algorithms including lanreotide Autogel are 14-34% more expensive than algorithms including octreotide long-acting release. These life-long costs should be taken into consideration when making choices between treatment algorithms.

Clinical, quality of life, and economic value of acromegaly disease control

“…A cost-effective treatment strategy appears to be first-line surgery followed when needed by second-line octreotide LAR [6]. The goals of treatment are to achieve disease control, while minimizing adverse effects [1].…”

The real costs of acromegaly: analysis of different therapies

“…Thus, the higher the success rate of surgery, the lower the cost of treatment [13]. Biermasz et al calculated that with the effectiveness of the procedure at the level of 80% in relation to 60% lifelong costs for 100 patients decrease by more than three times [14]. The effectiveness of the procedure depends to a great extent on the surgeon's experience; hence, the strategy of referring a patient with acromegaly qualified for surgery to a specialized centre has, among others, also potential pharmacoeconomic justification.…”

“…EUR 12,000. For comparison, the annual costs for pharmacological treatment ranged between approximately EUR 7900 and 84,900 per patient depending on the type and dose of the preparation [14]. Cost of single surgery in Poland in 2016, either transcranial or transsphenoidal, paid by the public payer was around PLN 15,450 (circa EUR 3450) [17].…”

Comparative effectiveness review of treatment options for pituitary microadenomas in acromegaly

“…Finally, the combination of somatostatin analog/pegvisomant can be administered if all other modalities have been unsuccessful. 10 The mean cost of each drug was then calculated based on specific dose prices and multiplied by the number of doses per year (13 doses in a 52-week period) to determine annual cost. The mean annual cost for octreotide is therefore calculated as $43,526, and the mean annual cost for lanreotide is $41,216 ( Table 7).…”