Cost-Utility of Acromegaly Pharmacological Treatments in a French Context
Thierry Brue
(1, 2, 3, 4)
,
Philippe Chanson
(5, 6)
,
Patrice Rodien
(7, 8)
,
Brigitte Delemer
(9)
,
Delphine Drui
(10, 11)
,
Lucile Marié
(12)
,
Laurène Juban
(12)
,
Lara Salvi
(13)
,
Robin Henocque
(12)
,
Gérald Raverot
(14)
1
MMG -
Marseille medical genetics - Centre de génétique médicale de Marseille
2 MarMaRa - Institut Marseille Maladies Rares
3 Service d'endocrinologie, diabète, maladies métaboliques [Hôpital de la Conception - APHM]
4 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
5 PHYSENDO - Physiologie et physiopathologie endocriniennes
6 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
7 CHU Angers - Centre Hospitalier Universitaire d'Angers
8 UA - Université d'Angers
9 CHU Reims - Hôpital universitaire Robert Debré [Reims]
10 ITX - ITX - unité de recherche de l'institut du thorax
11 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
12 stève consultants [Oullins]
13 Pfizer France
14 GHE - Groupement Hospitalier Lyon-Est
2 MarMaRa - Institut Marseille Maladies Rares
3 Service d'endocrinologie, diabète, maladies métaboliques [Hôpital de la Conception - APHM]
4 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
5 PHYSENDO - Physiologie et physiopathologie endocriniennes
6 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
7 CHU Angers - Centre Hospitalier Universitaire d'Angers
8 UA - Université d'Angers
9 CHU Reims - Hôpital universitaire Robert Debré [Reims]
10 ITX - ITX - unité de recherche de l'institut du thorax
11 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
12 stève consultants [Oullins]
13 Pfizer France
14 GHE - Groupement Hospitalier Lyon-Est
Thierry Brue
- Fonction : Auteur
- PersonId : 16653
- IdHAL : thierry-brue
- ORCID : 0000-0001-8482-6691
- IdRef : 058613439
Philippe Chanson
- Fonction : Auteur
- PersonId : 1329835
- IdHAL : philippe-chanson
- ORCID : 0000-0001-5096-5722
- IdRef : 029294452
Patrice Rodien
- Fonction : Auteur
- PersonId : 766268
- ORCID : 0000-0002-7785-5627
- IdRef : 103208410
Gérald Raverot
- Fonction : Auteur
- PersonId : 763607
- ORCID : 0000-0002-9517-338X
- IdRef : 073657905
Résumé
Objective Efficacy of pharmacological treatments for acromegaly has been assessed in many clinical or real-world studies but no study was interested in economics evaluation of these treatments in France. Therefore, the objective of this study was to estimate the cost-utility of second-line pharmacological treatments in acromegaly patients. Methods A Markov model was developed to follow a cohort of 1,000 patients for a lifetime horizon. First-generation somatostatin analogues (FGSA), pegvisomant, pasireotide and pegvisomant combined with FGSA (off label) were compared. Efficacy was defined as the normalization of insulin-like growth factor-1 (IGF-1) concentration and was obtained from pivotal trials and adjusted by a network meta-analysis. Costs data were obtained from French databases and literature. Utilities from the literature were used to estimate quality-adjusted life year (QALY). Results The incremental cost-utility ratios (ICUR) of treatments compared to FGSA were estimated to be 562,463 € per QALY gained for pasireotide, 171,332 € per QALY gained for pegvisomant, and 186,242 € per QALY gained for pegvisomant + FGSA. Pasireotide seems to be the least cost-efficient treatment. Sensitivity analyses showed the robustness of the results. Conclusion FGSA, pegvisomant and pegvisomant + FGSA were on the cost-effective frontier, therefore, depending on the willingness-to-pay for an additional QALY, they are the most cost-effective treatments. This medico-economic analysis highlighted the consistency of the efficiency results with the efficacy results assessed in the pivotal trials. However, most recent treatment guidelines recommend an individualized treatment strategy based on the patient and disease profile.
Format du dépôt | Fichier |
---|---|
Type de dépôt | Article dans une revue |
Titre |
en
Cost-Utility of Acromegaly Pharmacological Treatments in a French Context
|
Résumé |
en
Objective Efficacy of pharmacological treatments for acromegaly has been assessed in many clinical or real-world studies but no study was interested in economics evaluation of these treatments in France. Therefore, the objective of this study was to estimate the cost-utility of second-line pharmacological treatments in acromegaly patients. Methods A Markov model was developed to follow a cohort of 1,000 patients for a lifetime horizon. First-generation somatostatin analogues (FGSA), pegvisomant, pasireotide and pegvisomant combined with FGSA (off label) were compared. Efficacy was defined as the normalization of insulin-like growth factor-1 (IGF-1) concentration and was obtained from pivotal trials and adjusted by a network meta-analysis. Costs data were obtained from French databases and literature. Utilities from the literature were used to estimate quality-adjusted life year (QALY). Results The incremental cost-utility ratios (ICUR) of treatments compared to FGSA were estimated to be 562,463 € per QALY gained for pasireotide, 171,332 € per QALY gained for pegvisomant, and 186,242 € per QALY gained for pegvisomant + FGSA. Pasireotide seems to be the least cost-efficient treatment. Sensitivity analyses showed the robustness of the results. Conclusion FGSA, pegvisomant and pegvisomant + FGSA were on the cost-effective frontier, therefore, depending on the willingness-to-pay for an additional QALY, they are the most cost-effective treatments. This medico-economic analysis highlighted the consistency of the efficiency results with the efficacy results assessed in the pivotal trials. However, most recent treatment guidelines recommend an individualized treatment strategy based on the patient and disease profile.
|
Auteur(s) |
Thierry Brue
1, 2, 3, 4
, Philippe Chanson
5, 6
, Patrice Rodien
7, 8
, Brigitte Delemer
9
, Delphine Drui
10, 11
, Lucile Marié
12
, Laurène Juban
12
, Lara Salvi
13
, Robin Henocque
12
, Gérald Raverot
14
1
MMG -
Marseille medical genetics - Centre de génétique médicale de Marseille
( 527039 )
- Faculté de Médecine - Timone
27, boulevard Jean Moulin
13385 Marseille cedex 5
- France
2
MarMaRa -
Institut Marseille Maladies Rares
( 1006998 )
- Institut MarMaRa
MMG-Faculté de Médecine
27 bd Jean Moulin, 13385 Marseille Cedex 5
- France
3
Service d'endocrinologie, diabète, maladies métaboliques [Hôpital de la Conception - APHM]
( 533507 )
- France
4
LA CONCEPTION -
Hôpital de la Conception [CHU - APHM]
( 417872 )
- 147 Boulevard Baille 13005 Marseille
- France
5
PHYSENDO -
Physiologie et physiopathologie endocriniennes
( 1041849 )
- 63 rue Gabriel Péri, 94276, Le Kremlin-Bicêtre cedex
- France
6
Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
( 312432 )
- 78 Rue du Général Leclerc 94270 Le Kremlin-Bicêtre
- France
7
CHU Angers -
Centre Hospitalier Universitaire d'Angers
( 151939 )
- 4 rue Larrey - 49933 Angers cedex 9
- France
8
UA -
Université d'Angers
( 74911 )
- Université d'Angers - 40 Rue de Rennes, BP 73532 - 49035 Angers CEDEX 01
- France
9
CHU Reims -
Hôpital universitaire Robert Debré [Reims]
( 417765 )
- rue du General Koenig 51090 Reims Cedex
- France
10
ITX -
ITX - unité de recherche de l'institut du thorax
( 182196 )
- 8 quai Moncousu - BP 70721 - 44007 Nantes Cedex 1
- France
11
CHU Nantes -
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
( 474972 )
- 1 Place Alexis-Ricordeau, 44000 Nantes
- France
12
stève consultants [Oullins]
( 1005858 )
- France
13
Pfizer France
( 204305 )
- 23 avenue du Dr Lannelongue 75668 Paris cedex 14
- France
14
GHE -
Groupement Hospitalier Lyon-Est
( 212722 )
- 59 Boulevard Pinel 69677 Bron
- France
|
Langue du document |
Anglais
|
Nom de la revue |
|
Volume |
12
|
Date de publication |
2021-10-07
|
Audience |
Internationale
|
Vulgarisation |
Non
|
Comité de lecture |
Oui
|
Page/Identifiant |
745843
|
Domaine(s) |
|
Mots-clés |
en
QALY, acromegaly, cost-utility, growth hormone, insulin-like growth factor-1, pasireotide, pegvisomant, somatostatin
|
DOI | 10.3389/fendo.2021.745843 |
Pubmed Id | 34690933 |
PubMed Central | PMC8531881 |
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