title: Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study.
abstract: OBJECTIVE
  Acromegaly is a complex endocrine disease with multiple comorbidities. Treatment to obtain biochemical remission includes surgery, medical therapy and radiation. We aimed to describe comorbidities, treatment patterns and cost-of-illness in patients with acromegaly in Sweden.
  
  
  METHODS
  A nationwide population-based study.
  
  
  METHODS
  Patients with acromegaly were identified and followed in national registers in Sweden. Longitudinal treatment patterns were assessed in patients diagnosed between July 2005 and December 2013. The cost-of-illness during 2013 was estimated from a societal perspective among patients diagnosed between 1987 and 2013.
  
  
  RESULTS
  Among 358 patients with acromegaly (48% men, mean age at diagnosis 50.0 (s.d. 15.3) years) at least one comorbidity was reported in 81% (n = 290). The most common comorbidities were hypertension (40%, n = 142), neoplasms outside the pituitary (30%, n = 109), hypopituitarism (22%, n = 80) and diabetes mellitus (17%, n = 61). Acromegaly treatment was initiated on average 3.7 (s.d. 6.9) months after diagnosis. Among the 301 treated patients, the most common first-line treatments were surgery (60%, n = 180), somatostatin analogues (21%, n = 64) and dopamine agonists (14%, n = 41). After primary surgery, 24% (n = 44) received somatostatin analogues. The annual per-patient cost was €12 000; this was €8700 and €16 000 if diagnosed before or after July 2005, respectively. The cost-of-illness for acromegaly and its comorbidities was 77% from direct costs and 23% from production loss.
  
  
  CONCLUSIONS
  The prevalence of comorbidity is high in patients with acromegaly. The most common first-line treatment in acromegalic patients was surgery followed by somatostatin analogues. The annual per-patient cost of acromegaly and its comorbidities was €12 000.
authors.affiliation: Nordic Health EconomicsGothenburg, Sweden eva.lesen@nordichealtheconomics.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Lesén
authors.affiliation: Nordic Health EconomicsGothenburg, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Granfeldt
authors.affiliation: IpsenBoulogne-Billancourt, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Houchard
authors.affiliation: IpsenBoulogne-Billancourt, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dinet
authors.affiliation: IpsenBoulogne-Billancourt, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Berthon
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Olsson
authors.affiliation: Nordic Health EconomicsGothenburg, Sweden.
authors.forename: Ingela
authors.initials: I
authors.lastname: Björholt
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D015897:Comorbidity; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013548:Sweden