Objective

Acromegaly is a rare, pituitary hormonal disorder that requires improved awareness worldwide. The objective of this analysis was to quantify the clinical and economic burden of comorbidities for patients with acromegaly and examine the influence of biochemical control on these outcomes.

Study design

Markov cohort decision analytic model consisting of two states, including alive (with and without comorbidity) and dead.

Methods

A cohort of patients with acromegaly who had achieved biochemical control, a cohort of patients with acromegaly who had not achieved biochemical control, and a cohort of individuals from the general US population were tracked over a lifetime time horizon. The model tracked the proportion of the alive population that had each comorbidity based on age, sex, presence of acromegaly, and biochemical control status. The proportion of patients with each acromegaly-associated comorbidity were assigned comorbidity-associated costs, disutilities, and increased risk of mortality.

Results

Compared with the general population, controlled acromegaly resulted in $192,000 additional comorbidity-related costs, 0.7 fewer years of life, 2.9 fewer quality-adjusted life years, and 1.1 more comorbidities across the remaining lifespan. Compared with the general population, uncontrolled acromegaly resulted in $285,000 additional comorbidity-related costs, 0.9 fewer years of life, 4.2 fewer quality-adjusted life years, and 1.6 more comorbidities across the remaining lifespan.

Conclusions

Achieving biochemical control is associated with improvements in cost, quality of life, and mortality, albeit not to the level of the general population. A multimodal treatment strategy including biochemical control and management of comorbidities is necessary to improve patient outcomes.

中文翻译：

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肢端肥大症患者合并症的经济和临床负担

客观的

肢端肥大症是一种罕见的垂体激素紊乱，需要全世界提高认识。该分析的目的是量化肢端肥大症患者合并症的临床和经济负担，并检查生化控制对这些结果的影响。

学习规划

马尔可夫队列决策分析模型由两种状态组成，包括活着（有和没有合并症）和死亡。

方法

在终生时间范围内跟踪了一组已实现生化控制的肢端肥大症患者、一组未实现生化控制的肢端肥大症患者以及一组来自美国普通人群的个体。该模型根据年龄、性别、肢端肥大症的存在和生化控制状态跟踪了患有每种合并症的活人口的比例。每种肢端肥大症相关合并症的患者比例被分配与合并症相关的费用、负效用和死亡风险增加。

结果

与普通人群相比，受控制的肢端肥大症导致与合并症相关的额外费用为 192,000 美元，生命年减少 0.7 年，质量调整生命年减少 2.9 年，剩余寿命期间合并症增加 1.1 次。与普通人群相比，不受控制的肢端肥大症导致与合并症相关的额外费用为 285,000 美元，生命年减少 0.9 年，质量调整生命年减少 4.2 年，剩余寿命中合并症增加 1.6 年。

结论

实现生化控制与成本、生活质量和死亡率的改善有关，尽管没有达到一般人群的水平。包括生化控制和合并症管理在内的多模式治疗策略对于改善患者预后是必要的。