title: Clinical, quality of life, and economic value of acromegaly disease control.
abstract: Although acromegaly is a rare disease, the clinical, economic and health-related quality of life (HRQoL) burden is considerable due to the broad spectrum of comorbidities as well as the need for lifelong management. We performed a comprehensive literature review of the past 12 years (1998-2010) to determine the benefit of disease control (defined as a growth hormone [GH] concentration <2.5 μg/l and insulin-like growth factor [IGF]-1 normal for age) on clinical, HRQoL, and economic outcomes. Increased GH and IGF-1 levels and low frequency of somatostatin analogue use directly predicted increased mortality risk. Clinical outcome measures that may improve with disease control include joint articular cartilage thickness, vertebral fractures, left ventricular function, exercise capacity and endurance, lipid profile, and obstructive apnea events. Some evidence suggests an association between controlled disease and improved HRQoL. Total direct treatment costs were higher for patients with uncontrolled compared to controlled disease. Costs incurred for management of comorbidities, and indirect cost could further add to treatment costs. Optimizing disease control in patients with acromegaly appears to improve outcomes. Future studies need to evaluate clinical outcomes, as well as HRQoL and comprehensive economic outcomes achieved with controlled disease.
authors: Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, 110 George Burns Rd, Los Angeles, CA, 90048, USA.
authors: A
authors: A
authors: Ben-Shlomo
authors: M C
authors: MC
authors: Sheppard
authors: J M
authors: JM
authors: Stephens
authors: S
authors: S
authors: Pulgar
authors: S
authors: S
authors: Melmed
references: Expert Rev Pharmacoecon Outcomes Res. 2009 Jun;9(3):223-34
references: 19527094
references: J Clin Endocrinol Metab. 2005 Jul;90(7):4081-6
references: 15886256
references: BMJ. 2010 Aug 16;341:c4189
references: 20713585
references: Circulation. 2009 Jan 27;119(3):480-6
references: 19171871
references: Endocr Pract. 2007 Jul-Aug;13(4):363-72
references: 17669712
references: Eur J Endocrinol. 2007 Oct;157(4):411-7
references: 17893254
references: J Clin Endocrinol Metab. 1998 Jun;83(6):2121-5
references: 9626149
references: Clin Endocrinol (Oxf). 2003 Feb;58(2):169-76
references: 12580932
references: J Clin Endocrinol Metab. 2002 Jul;87(7):3097-104
references: 12107207
references: Eur J Endocrinol. 2002 Mar;146(3):303-9
references: 11888835
references: Med Care Res Rev. 2000 Mar;57(1):92-109
references: 10705704
references: J Clin Endocrinol Metab. 2000 Sep;85(9):3132-40
references: 10999798
references: Am J Manag Care. 2008 Sep;14(9):605-15
references: 18778176
references: Endocr Rev. 2004 Feb;25(1):102-52
references: 14769829
references: Mol Cell Endocrinol. 2008 May 14;286(1-2):192-8
references: 18191325
references: J Endocrinol Invest. 2004 Dec;27(11):1034-9
references: 15754735
references: Acta Neurochir (Wien). 2005 Mar;147(3):243-51; discussion 250-1
references: 15627919
references: J Clin Endocrinol Metab. 2004 Apr;89(4):1613-7
references: 15070920
references: Horm Res. 2007;68 Suppl 5:166-72
references: 18174739
references: J Clin Endocrinol Metab. 1998 Oct;83(10):3411-8
references: 9768640
references: Eur J Endocrinol. 2008 Nov;159(5):525-32
references: 18755874
references: Am J Cardiol. 1999 May 15;83(10):1506-9, A8
references: 10335774
references: Pituitary. 2003;6(4):203-7
references: 15237931
references: Neuroendocrinology. 2006;83(3-4):249-57
references: 17047390
references: Clin Endocrinol (Oxf). 1999 Nov;51(5):611-8
references: 10594522
references: J Bone Miner Res. 2005 Oct;20(10):1837-44
references: 16160741
references: Eur J Endocrinol. 2003 Jan;148(1):31-8
references: 12534355
references: Rev Endocr Metab Disord. 2009 Jun;10(2):135-44
references: 18787957
references: Pituitary. 1999 Jun;2(1):29-41
references: 11081170
references: Health Qual Life Outcomes. 2004 Feb 27;2:13
references: 14987332
references: J Endocrinol. 1997 Oct;155 Suppl 1:S41-4; discussion S45
references: 9389994
references: Clin Endocrinol (Oxf). 2002 Dec;57(6):713-7
references: 12460319
references: J Clin Endocrinol Metab. 1999 Feb;84(2):527-32
references: 10022411
references: J Clin Endocrinol Metab. 2001 Apr;86(4):1551-7
references: 11297582
references: J Endocrinol Invest. 2002 Dec;25(11):971-6
references: 12553557
references: J Clin Endocrinol Metab. 2008 Jun;93(6):2035-41
references: 18381584
references: J Clin Endocrinol Metab. 1998 Oct;83(10):3419-26
references: 9768641
references: Eur J Endocrinol. 2008 Aug;159(2):89-95
references: 18524797
references: Eur J Endocrinol. 2008 Nov;159(5):533-40
references: 18765561
references: J Clin Endocrinol Metab. 1999 Jan;84(1):17-23
references: 9920056
references: Eur J Endocrinol. 2006 Dec;155(6):831-7
references: 17132752
references: Lancet. 1998 Oct 31;352(9138):1455-61
references: 9808008
references: Eur J Endocrinol. 2008 Mar;158(3):305-10
references: 18299462
references: J Clin Endocrinol Metab. 2000 Jan;85(1):168-74
references: 10634382
references: J Clin Endocrinol Metab. 2004 Jun;89(6):2789-96
references: 15181059
references: Pituitary. 2001 Sep;4(4):259-62
references: 12501976
references: J Clin Endocrinol Metab. 2009 Nov;94(11):4216-23
references: 19808848
references: J Clin Endocrinol Metab. 2010 Aug;95(8):3648-56
references: 20463098
references: Eur J Endocrinol. 2005 Aug;153(2):231-8
references: 16061829
references: Eur J Endocrinol. 2007 Oct;157(4):399-409
references: 17893253
references: Clin Endocrinol (Oxf). 2005 Jul;63(1):103-10
references: 15963069
references: Clin Endocrinol (Oxf). 2003 Jan;58(1):86-91
references: 12519417
references: Drugs. 2009 Nov 12;69(16):2207-26
references: 19852525
references: Neuroendocrinology. 2006;83(3-4):211-7
references: 17047385
references: Clin Endocrinol (Oxf). 2008 Aug;69(2):279-84
references: 18194486
references: Sleep. 1999 Sep 15;22(6):749-55
references: 10505820
references: N Engl J Med. 2006 Dec 14;355(24):2558-73
references: 17167139
references: Eur J Endocrinol. 2004 Oct;151(4):439-46
references: 15476442
references: J Clin Endocrinol Metab. 2008 Jan;93(1):61-7
references: 17971431
references: J Endocrinol Invest. 2007 Jul-Aug;30(7):541-5
references: 17848835
references: Atherosclerosis. 2000 Aug;151(2):551-7
references: 10924734
references: J Clin Endocrinol Metab. 2009 May;94(5):1509-17
references: 19208732