OBJECTIVES: The objective is to describe disease progression and treatment patterns of acromegaly in patients with inadequate biochemical control, assess how biochemical control will impact disease progression and treatment pathways and estimate the economic efficiency of pasireotide long-acting (PASI) in a treatment of acromegaly in Finland. PASI is compared to pegvisomant + somatostatin analoque (PEG+SSA) in patients with inadequately controlled acromegaly. METHODS: A 5-state Markov model describing the disease progression and management of acromegaly was constructed. The model enables an assessment of how biochemical control associated with PASI is translated into Quality Adjusted Life Years (QALYs), costs and subsequently incremental cost-effectiveness ratio. Transition probabilities were determined by clinical trial data (study 2402) in 6 month cycles. Achievement of control has an impact on quality of life, mortality risk and prevalence of comorbidities, whereas achievement of tumor reduction will have an impact on quality of life. Utilities for each health state were derived from the 2402 trial and the literature. The annual visit, monitoring and comorbidity costs were estimated by treatment response and were based on patient level data (n=66) from Auria biobank. The analysis was undertaken from health care payer perspective using 30-years time horizon. RESULTS: PASI dominated PEG+SSA treatment strategy. PASI was associated with more than 100,000€ lower costs compared to PEG+SSA. This is primarily driven by the lower pharmaceutical cost.PASI patients were on average 0.19 more years in biochemical control compared with PEG+SSA and was associated with QALY gain of 0.02. The difference in QALYs result from the tumor reduction achieved with PASI as well as the drop-out rate due to liver toxicities occurring in PEG+SSA strategy. CONCLUSIONS: PASI provides a valuable addition to the treatment options for patients with acromegaly and can achieve mortality as well as morbidity improvements in a cost-effective way in Finland.