Treatment Patterns and Economic Burden in Patients Treated for Acromegaly in the USA

Abstract

BackgroundAcromegaly is a rare, debilitating condition for which data on the associated treatment patterns and economic burden are limited.ObjectiveOur objective was to examine patient characteristics, treatment patterns, and healthcare resource utilization (HRU)/costs for individuals with acromegaly treated with surgical and/or medical therapy in the USA.MethodsUsing a large US claims database, adults with new episodes of acromegaly between 1 July 2007 and 31 December 2010 were identified (the first observed diagnosis being the index date). Patients had 6-month pre-index and 12-month post-index continuous enrollment and surgical and/or medical treatment during the 12-month post-index period. Descriptive analysis was performed to observe demographic/clinical characteristics, treatment patterns, HRU, and monthly healthcare costs between two mutually exclusive surgically and medically treated cohorts.ResultsThis study included 228 acromegalic individuals treated with surgical therapy and 169 treated with medical therapy. During the 12-month follow-up, compared with the medical cohort, the surgical cohort were more likely to have hypertension (50.4 vs. 32.0 %), sleep apnea (31.6 vs. 15.8 %), cardiac dysrhythmia (16.7 vs. 7.0 %), hospitalizations (98.3 vs. 13.6 %), and emergency room visits (29.8 vs. 20.7 %), and had more outpatient visits (10.2 vs. 5.2) and physician office visits (21.2 vs. 15.0) (all differences, p < 0.05). The surgical cohort had lower monthly healthcare costs during the 6-month pre-index period ($US1963.5 vs. 2818.4) but higher costs in the 12-month post-index period ($US5202.6 vs. 3076.5) than the medical cohort.ConclusionsOur findings suggest the treatment pathway observed in this patient population has a non-negligible association with the clinical and economic burden.

Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care

“…Both groups utilized the physician's office most often, followed by outpatient facilities, laboratory services, and other sites of care, even though the frequency of use was quite different between groups for most venues. Finding that healthcare service use in general was significantly greater (in many cases, several-times greater) for patients with acromegaly, this analysis corroborates and builds upon previous estimates of the economic burden of acromegaly [7,16,19,29].…”

“…Using administrative coding for patient identification, this methodology permitted exclusion of patients with other conditions, such as Cushing's disease, without relying on patient recall or subjective measures. By contrast, previous studies [7,16,18,29] did not exclude patients with Cushing's disease or other pituitary disorders. Though not the primary focus, this study also explored the impact of concurrent hypopituitarism.…”

“…Research has been published recently on the economic impact of acromegaly, including health services utilized by patients with acromegaly and health expenditures associated with the condition [14][15][16][17][18]. In an effort to bolster this information, Yuen and colleagues [19] evaluated how acromegaly influenced direct medical and prescription costs, indirect costs, and lost work time associated with absences and disability.…”

Health Benefit Costs and Absenteeism Among Employed Patients With Acromegaly

“…Chuang and colleagues 8 published the results of claims database analysis from 2007 to 2010 of 397 patients with acromegaly and stratified them into groups receiving surgical resection with/without medical therapy or medical therapy only. Their study demonstrated that patients who had received surgery had 69% higher mean direct healthcare costs compared with those in the medical therapy only.…”

“…Some studies of acromegaly that have been published utilize federal or commercial databases to analyze prevalence, treatment patterns, and adherence. [6][7][8][9][10] However, data on the impact of acromegaly on employees' health costs (direct and indirect) are limited. Furthermore, even less J o u r n a l P r e -p r o o f 6 | P a g e Running Title: Costs in Patients with Acromegaly information is available on the burden of acromegaly from an employer's perspective, including health benefit costs and worker productivity.…”