New Epidemiological, Clinical and Economic Data for Patients With Acromegaly in Bulgaria

Abstract

Background: Acromegaly and its comorbidities affect the patients' quality of life, each healthcare system and the society. This study aimed to evaluate clinical characteristics and treatment patterns and the economic burden of acromegaly.Materials and methods: All patients with acromegaly treated with expensive medicines and regularly followed up at the main expert clinical center for acromegaly in the country were included in this nationwide, retrospective, observational, population-based study. Patient characteristics, treatment patterns, healthcare resource use, and costs were assessed for 1-year period (01. 01.2018-31.12.2018). Results were processed through statistical analysis using MedCalc software version 16.4.1.Results: A total of 191 acromegaly patients were observed. Approximately 67% were female, 45.5% were between 41 and 60 years and the mean age at diagnosis was 40.73 years. Surgical treatment was preferred as a first-line therapy among almost 89% of all diagnosed patients. The level of comorbidities was very high as more than 95% suffered from at least one concomitant disease. The most frequent comorbidities were other endocrine and metabolic diseases (96.7%), followed by cardiovascular diseases (70.7%). The most common first-line pharmacotherapy was long-acting somatostatin analogs (SSA) (38%) followed by dual combination SSA + pegvisomant (21%). The total economic burden of acromegaly was estimated to be 2,674,499.90 e in 2018 as the direct costs (medication costs, hospitalization costs covered by the patients and the National Health Insurance Fund) outnumbered indirect costs (loss of productivity due to hospitalization): 2,630,568.58 e vs. 43,931.32 e. The average annual per-patient direct and indirect costs were 14,002.62 e. Conclusions:The current study demonstrates a significant clinical and socio-economic burden of acromegaly in the country. Proper diagnosing and regular follow up of acromegaly patients in a specialized pituitary center ensure appropriate innovative pharmacotherapy with achievement of disease control.

Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study

“…The female sex was correlated with a diagnostic delay and more comorbidities at follow-up, consistent with previous results (8,19,27,29). The average age of patients was 39 years, approximately 10 years younger than the patients from Sweden, France, Denmark and the United States but close to those from Korea and Bulgaria (14,15,23,(30)(31)(32). We showed that older age was suggested to be correlated with more comorbidities, in accordance with published literature (33,34).…”

“…Acromegaly affects both males and females; many studies have demonstrated that females are more frequently affected, but some have indicated that both sexes are equally affected (9,14,15,17,18,21,22,(27)(28)(29). In the present study, females accounted for 58.8% of all patients, significantly larger than the percentage of males.…”

“…Treatments for acromegaly contribute to substantial economic burdens for patients (14,15). In this study, the mean personal cost of treatment was $11013 (€9333) among Chinese patients, which was lower than the €12000 to €14000 estimated in Western countries (14,32).…”

“…Disfigurement, physical problems, and psychological disorders caused by acromegaly and the frequent need for treatment contribute to unemployment among patients with acromegaly (14,32,57). In this population, over one-fourth of the patients became unemployed after being diagnosed with acromegaly.…”

“…However, tumor recurrence and high hormone concentrations occur in almost half of patients after treatment, leading to persistent symptoms and comorbidities and thus deteriorating patient prognosis and influencing the overall well-being of these patients (4,7). Apart from the negative health-related effects, acromegaly also leads to a considerable economic burden for patients themselves, their families, the healthcare system and society as a whole (14,15).…”