OBJECTIVES:

Context: The Cost-utility of second-line Acromegaly treatments in France has already been assessed in 2021 in a previous paper “ Cost-utility of Acromegaly Pharmacological Treatments in a French Context”. The aim of this study is to update the 2021 medico-economic analysis including further treatment lines to better describe a complete healthcare pathway.

Objective: The purpose of this new analysis is to reassess the efficiency of second-line drug therapy [pegvisomant, pasireotide, and pegvisomant combined with First Generation Somatostatin Analogues (FGSA)], considering the results of first-line treatments (surgery, FGSA, cabergoline and combinations) and radiotherapy. Treatment efficacy is defined on both normalization of Insulin Growth Factor 1 (IGF-1) and effect on tumor volume

METHODS:

The prior 3-state Markov model has been revised to include an additional health state, representing patients who are controlled without pharmacological treatment following successful radiotherapy. The model accounted for the history of first-line treatments as additional costs for patients upon entry. A cohort of 1.000 simulated patients was followed over a lifetime horizon from a collective perspective. The efficacy of second-line treatments was determined through a network meta-analysis. Cost and utility data were sourced from French databases and literature.

RESULTS: The analysis results are illustrated on a cost-utility frontier, classifying treatments according to the calculated incremental cost-utility ratios (ICUR), expressed as cost per QALY. To gauge the robustness of these findings, results of both deterministic and probabilistic sensitivity analysis are provided

CONCLUSIONS: The updated model aims to offer a more thorough and comprehensive view of the cost-utility of second-line pharmacological treatments in acromegaly. Beyond clinical data, this analysis broadens our perspective within a framework where costs of treatments are rising, and healthcare system financing is more challenging.