title: Longitudinal assessment of economic burden and clinical outcomes in acromegaly.
abstract: OBJECTIVE
  To determine costs and outcomes over time for surgical and various medical regimens in the management of patients with acromegaly.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Pharmacy, University of California, San Francisco, California 94143, USA.
authors: L S
authors: LS
authors: Wilson
authors: J L
authors: JL
authors: Shin
authors: S
authors: S
authors: Ezzat
mesh_terms: D000172:Acromegaly / Q000191:economics* / Q000628:therapy*; D017281:Cost of Illness; D016527:Drug Costs; D005260:Female; D013502:General Surgery / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019233:Retreatment; D016896:Treatment Outcome