title: Multi-modal management of acromegaly: a value perspective.
abstract: OBJECTIVE
  The Acromegaly Consensus Group recently released updated guidelines for medical management of acromegaly patients. We subjected these guidelines to a cost analysis.
  
  
  METHODS
  We conducted a cost analysis of the recommendations based on published efficacy rates as well as publicly available cost data. The results were compared to findings from a previously reported comparative effectiveness analysis of acromegaly treatments. Using decision tree software, two models were created based on the Acromegaly Consensus Group's recommendations and the comparative effectiveness analysis. The decision tree for the Consensus Group's recommendations was subjected to multi-way tornado analysis to identify variables that most impacted the value analysis of the decision tree.
  
  
  RESULTS
  The value analysis confirmed the Consensus Group's recommendations of somatostatin analogs as first line therapy for medical management. Our model also demonstrated significant value in using dopamine agonist agents as upfront therapy as well. Sensitivity analysis identified the cost of somatostatin analogs and growth hormone receptor antagonists as having the most significant impact on the cost effectiveness of medical therapies.
  
  
  CONCLUSIONS
  Our analysis confirmed the value of surgery as first-line therapy for patients with surgically accessible lesions. Surgery provides the greatest value for management of patients with acromegaly. However, in accordance with the Acromegaly Consensus Group's recent recommendations, somatostatin analogs provide the greatest value and should be used as first-line therapy for patients who cannot be managed surgically. At present, the substantial cost is the most significant negative factor in the value of medical therapies for acromegaly.
authors.affiliation: The Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY, 14642, USA, kristopher_kimmell@urmc.rochester.edu.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kimmell
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Marko
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D003131:Combined Modality Therapy; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D018491:Dopamine Agonists / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D004359:Drug Therapy, Combination; D017048:Health Care Costs; D006727:Hormone Antagonists / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D018803:Models, Economic; D019635:Neurosurgical Procedures / Q000191:economics*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D016634:Radiosurgery / Q000191:economics*; D013004:Somatostatin / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists; D006727:Hormone Antagonists; D013004:Somatostatin