Luque-Ramírez M, Paramo C, Varela da Costa C, García-Mayor R V
Department of Endocrinology, University Hospital of La Princesa, 28006 Madrid, Spain.
J Endocrinol Invest. 2007 Jul-Aug;30(7):541-5. doi: 10.1007/BF03346346.
At the time of diagnosis, macroadenomas represent 60-80% of GH secreting adenomas, of which 25-30% are invasive macroadenomas. These aggressive tumors have the worst surgical success rates in terms of cure, and often need several therapeutic approaches in order to control disease status. Acromegalic patients are subject to increased mortality and important health resource consumption related to their associated co-morbidities, in addition to the costs that are related to diagnosis itself and initial treatment of the disease.
Assessment of the cost of initial management and outcome of acromegalic patients with invasive pituitary adenomas.
Retrospective and observational study of review of records.
Two tertiary hospitals.
11 consecutive patients between 18 and 80 yr old diagnosed with acromegaly due to an invasive pituitary macroadenoma.
Collection of data of biochemical and radiological tests, specialist visits, hospitalisation, surgery, pharmacological and radiotherapy treatment at diagnosis and over 4 yr of follow-up after initial treatment. Costs were evaluated using the data of the Centre for Health Economics and Social Policy Studies and the Official College of Pharmacists of Spain.
Global and patient/yr follow-up costs of illness.
The mean costs for acromegaly for the period of follow-up ranged from 7,072 to 9,874 euro/patient/yr, for biochemically non-controlled (no.=6) and controlled patients (no.=5) respectively. The most important cost in the perioperative period was for admission in the intensive care unit. After surgery, SS analogues were the principal contributors to the economic burden.
In this paper we have for the first time presented a pharmacoeconomic study of GH secreting invasive macroadenoma. The poor prognosis of our cohort of patients and the higher rate of controlled patients and normal IGF-I levels warrant the employment of multiple therapeutic options. The cost associated with this treatment in this complex disease of low prevalence is not excessive and can be supported by healthcare services.
在诊断时，大腺瘤占生长激素分泌型腺瘤的60 - 80%，其中25 - 30%为侵袭性大腺瘤。这些侵袭性肿瘤在治愈方面手术成功率最差，并且常常需要多种治疗方法来控制疾病状态。除了与疾病诊断本身及初始治疗相关的费用外，肢端肥大症患者还因相关合并症面临死亡率增加和大量医疗资源消耗的问题。
评估侵袭性垂体腺瘤所致肢端肥大症患者初始治疗的费用及治疗结果。
回顾性观察研究，查阅病历。
两家三级医院。
11例年龄在18至80岁之间、因侵袭性垂体大腺瘤诊断为肢端肥大症的连续患者。
收集诊断时及初始治疗后4年随访期间的生化和放射学检查、专科就诊、住院、手术、药物及放射治疗的数据。使用西班牙卫生经济与社会政策研究中心及西班牙药剂师官方学院的数据评估费用。
疾病的总体及患者每年随访费用。
随访期间，生化指标未得到控制的患者（n = 6）和得到控制的患者（n = 5），肢端肥大症的平均费用分别为每年7,072至9,874欧元/患者。围手术期最重要的费用是重症监护病房的住院费用。手术后，生长抑素类似物是经济负担的主要来源。
本文首次对生长激素分泌型侵袭性大腺瘤进行了药物经济学研究。我们这组患者预后较差，而得到控制的患者比例及正常胰岛素样生长因子-I水平较高，这表明需要采用多种治疗方案。在这种低患病率的复杂疾病中，与这种治疗相关的费用并不过高，医疗服务能够承担。
