Objective: To estimate the cost-effectiveness of second-line pharmacological treatments in patients with acromegaly resistant to first-generation somatostatin analogues (FG SSA) from the Spanish National Health System (NHS) perspective. Methods: A Markov model was developed to analyze the cost-effectiveness of pegvisomant and pasireotide in FG SSA-resistant acromegaly, simulating a cohort of patients from the treatment beginning to death. Treatment with pegvisomant or pasireotide was compared to FG SSA retreatment. Efficacy data were obtained from clinical trials and utilities from the literature. Direct health costs were obtained from Spanish sources (€2018). Results: The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY). The ICER of pasireotide vs. FG SSA was €551,405/QALY. The ICER was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA). Conclusion: The ICER of pasireotide compared to FG SSA was six times higher than the ICER of pegvisomant vs. FG SSA. Pegvisomant is a more cost-effective alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.

中文翻译：

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西班牙肢端肥大症二线药物治疗的成本-效果分析。

目的：从西班牙国家卫生系统（NHS）的角度评估对第一代生长抑素类似物（FG SSA）肢端肥大症患者进行二线药物治疗的成本效益。方法：建立马尔可夫模型以分析培维索曼和帕雷肽在FG SSA耐药的肢端肥大症中的成本效果，模拟从治疗开始到死亡的一组患者。将培维索莫或帕瑞肽治疗与FG SSA再治疗进行了比较。从临床试验和文献中获得效用数据。直接卫生费用来自西班牙（2018欧元）。结果：培维索孟与FG SSA的增量成本效益比（ICER）为85,869欧元/质量调整生命年（QALY）。Pasireotide与FG SSA的ICER为551,405欧元/ QALY。ICER主要受功效提高的影响（培维索坦与FG SSA的QALY为4.41 QALY，帕西瑞肽vs. FG SSA为0.71 QALY），培维索莫坦的成本增幅（378,597欧元，FG SSA）要比帕西瑞肽（ 393,151欧元vs.FG SSA）。结论：帕西瑞肽的ICER比FG SSA高出六倍。对于西班牙NHS中FG SSA耐药患者的肢端肥大症，培维索孟特是一种更具成本效益的替代品。与FG SSA相比，帕瑞肽的ICER较培维索孟与FG SSA的ICER高出六倍。对于西班牙NHS中FG SSA耐药患者的肢端肥大症，培维索孟特是一种更具成本效益的替代品。与FG SSA相比，帕瑞肽的ICER较培维索孟与FG SSA的ICER高出六倍。对于西班牙NHS中FG SSA耐药患者的肢端肥大症，培维索孟特是一种更具成本效益的替代品。