title: Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome.
abstract: BACKGROUND
  There is no uniform standard of care for acromegaly. Due to the high costs involved, steps must be taken to ensure the cost-effective delivery of treatment.
  
  
  OBJECTIVE
  Taking the results of an earlier meta-analysis as a starting point, this study aims to determine whether treatment with long-acting somatostatin analogue (SSA) prior to surgery improves the cost-effectiveness of the treatment of acromegaly.
  
  
  METHODS
  The results are presented as an Incremental Cost Effectiveness Ratio (ICER) immediately after surgery, for the following year and over the next four decades. The cure rates percentage (95% CI) for the three randomized prospective controlled trials were 44.4% (34.2-54.7) and 18.2% (10.1-26.3) for preoperative treated and untreated patients respectively. The cost of pharmacological treatments was based on the number of units prescribed, dose and length of treatment.
  
  
  RESULTS
  The mean (95% CI) ICER immediately after surgery was €17,548 (12,007-33,250). In terms of the postoperative SSA treatment, the ICER changes from positive to negative before two years after surgery. One decade after surgery the ICER per patient/year was €-9973 (-18,798; -6752) for postoperative SSA treatment and €-31,733 (-59,812; -21,483) in the case of postoperative pegvisomant treatment.
  
  
  CONCLUSIONS
  In centres without optimal surgical results, preoperative treatment of GH-secreting pituitary macroadenomas with SSA not only shows a significant improvement in the surgical results, but is also highly cost-effective, with an ICER per patient/year one decade after surgery, of between €-9973 (-18,798; -6752) and €-31,733 (-59,812; -21,483) for SSA and pegvisomant respectively.
authors: Department of Pharmacy, University Hospital A Coruña, A Coruña, Spain.
authors: Luis
authors: L
authors: Margusino-Framiñán
authors: Clinical Epidemiology and Biostatistics Unit, University Hospital A Coruña, A Coruña, Spain.
authors: Sonia
authors: S
authors: Pertega-Diaz
authors: Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain.
authors: Lara
authors: L
authors: Pena-Bello
authors: Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain; Department of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain.
authors: Susana
authors: S
authors: Sangiao-Alvarellos
authors: Department of Endocrinology, University Hospital A Coruña, A Coruña, Spain.
authors: Elena
authors: E
authors: Outeiriño-Blanco
authors: Department of Endocrinology, University Hospital A Coruña, A Coruña, Spain.
authors: Francisco
authors: F
authors: Pita-Gutierrez
authors: Clinical Epidemiology and Biostatistics Unit, University Hospital A Coruña, A Coruña, Spain.
authors: Salvador
authors: S
authors: Pita-Fernandez
authors: Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain; Department of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain; Department of Endocrinology, University Hospital A Coruña, A Coruña, Spain. Electronic address: Fernando.Cordido.Carballido@sergas.es.
authors: Fernando
authors: F
authors: Cordido
mesh_terms: D000172:Acromegaly / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011986:Receptors, Somatotropin / Q000037:antagonists & inhibitors; D013004:Somatostatin / Q000031:analogs & derivatives*; D013030:Spain
chemical_list: D011986:Receptors, Somatotropin; D019382:Human Growth Hormone; D013004:Somatostatin; C406545:pegvisomant
keywords: Acromegaly; Cost-effectiveness analysis; Preoperative; Treatment