Dosing patterns, healthcare resource utilization and costs among acromegaly patients who consistently use lanreotide and injectable octreotide
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: In the US, lanreotide and injectable octreotide are commonly used to treat acromegaly. For most patients, the recommended injection administration regimen is every 4 weeks, or 13-times over the course of 1 year. The study aimed to quantify the proportion of patients who used a number of injections that is beyond the standard recommended regimen and to assess whether high frequency (HF) use is associated with higher healthcare resource utilization and costs. Materials & methods: IQVIA Pharmetrics Plus data between 1 January 2013 and 30 June 2023 was used to conduct a retrospective, observational study of acromegaly patients who used injectable octreotide or lanreotide for at least 2 years. The primary study outcomes were the number of injections and HF use. HF use is defined as having observed more than 13 injections over a 1-year observation period. Results: There were 420 patients with acromegaly who used injectable octreotide (n = 250) or lanreotide (n = 170) for a median of 4 years. HF use was observed in 32.4% of injectable octreotide users and 30.6% of lanreotide users. Over the course of 1 year, mean total healthcare costs were significantly higher among HF users compared with non-HF users among patients treated with injectable octreotide ($130,238 vs $85,964, p < 0.001) or lanreotide ($143,975 vs $96,518, p < 0.001). Additionally, 10% of HF users incurred $238,070–$281,167 or more. Based on the average cost per injection, patients with HF use had an additional $12,803–$13,480 in injection costs each year. Conclusion: Among those who are consistently treated, nearly a third of patients with acromegaly are HF users of lanreotide or injectable octreotide. The economic burden of HF use is high. Given the high proportion of patients who require administration beyond what is indicated on approved drug labels, further evaluation of new therapies is warranted.
Plain language summary
What is this article about?
We conducted this study to understand how often patients with acromegaly use more injections than the standard recommended dose on the US FDA approved drug labels and whether there is an association between high injection frequency, healthcare resources utilization and costs. The standard dosing regimen for lanreotide and for injectable octreotide is 1 injection every 4 weeks or 13 injections over the course of 1 year.
What were the results?
In this study we defined high frequency (HF) use as having more than 13 injections over 1 year. Nearly a third of patients who consistently use injectable octreotide or lanreotide to treat acromegaly were observed to have HF use. HF use is associated with higher all-cause total healthcare costs compared with non-HF use and 10% of HF users incurred $238,070–$281,167 or more in total healthcare costs over 1 year. HF use is also associated with higher healthcare resource utilization compared with non-HF user. For example, patients with HF use had higher rates of outpatient services, IGF-1 tests and pituitary MRIs compared with patients without HF use.
Why is this important?
HF use is higher than what has been reported in previous real-world evidence studies. An understanding of the relationship between higher-than-expected injection frequency and healthcare utilization and costs will inform healthcare decision-making. Given the high proportion of patients who require administration beyond what is indicated on approved drug labels and the increased costs associated with HF use, further evaluation of new therapies is warranted.
Supplementary Material
File (supplementary material.docx)
- Download
- 27.33 KB
References
Papers of special note have been highlighted as: • of interest
1.
Fleseriu M, Langlois F, Lim DST, Varlamov EV, Melmed S. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol. 10(11), 804–826 (2022).
2.
Ershadinia N, Tritos NA. Diagnosis and treatment of acromegaly: an update. Mayo Clin. Proc. 97(2), 333–346 (2022).
3.
Broder MS, Neary MP, Chang E, Cherepanov D, Katznelson L. Treatments, complications, and healthcare utilization associated with acromegaly: a study in two large United States databases. Pituitary 17(4), 333–341 (2014).
• This real-world evidence study assesses the burden of acromegaly by reporting the additional healthcare resource utilization and costs associated with complications of the disease.
4.
Burton T, Le Nestour E, Bancroft T, Neary M. Real-world comorbidities and treatment patterns of patients with acromegaly in two large US health plan databases. Pituitary 16(3), 354–362 (2013).
• This real-world evidence study found lower than expected rates of acromegaly treatment, considering that remission rates from surgery alone remain low.
5.
Fleseriu M, Barkan A, Brue T et al. Treatment patterns, adherence, persistence, and health care resource utilization in acromegaly: a real-world analysis. J. Endocr. Soc. 7(10), bvad104 (2023).
• This study used administrative claims data from MarketScan (2010–2022) and found that patient demographic characteristics are associated with treatment adherence, persistence and dosing patterns.
6.
Giustina A, Barkhoudarian G, Beckers A et al. Multidisciplinary management of acromegaly: a consensus. Rev. Endocr. Metab. Disord. 21(4), 667–678 (2020).
7.
Giustina A, Biermasz N, Casanueva FF et al. Consensus on criteria for acromegaly diagnosis and remission. Pituitary 27(1), 7–22 (2024).
8.
Melmed S, Bronstein MD, Chanson P et al. A consensus statement on acromegaly therapeutic outcomes. Nat. Rev. Endocrinol. 14(9), 552–561 (2018).
9.
Giustina A, Mazziotti G, Cannavò S et al. High-dose and high-frequency lanreotide autogel in acromegaly: a randomized, multicenter study. J. Clin. Endocrinol. Metab. 102(7), 2454–2464 (2017).
10.
Giustina A, Bonadonna S, Bugari G et al. High-dose intramuscular octreotide in patients with acromegaly inadequately controlled on conventional somatostatin analogue therapy: a randomised controlled trial. Eur. J. Endocrinol. 161(2), 331–338 (2009).
• Reports the effectiveness of a randomized intervention for high-dosing strength or high-dosing frequency, and found that high dose octreotide was an effective and safe strategy for disease management.
11.
Uygur MM, Villanova M, Frara S, Giustina A. Clinical pharmacology of oral octreotide capsules for the treatment of acromegaly. Touch Rev. Endocrinol. 20(1), 37–42 (2024).
12.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis. 40(5), 373–383 (1987).
13.
Abreu A, Tovar AP, Castellanos R et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary 19(4), 448–457 (2016).
14.
Whittington MD, Munoz KA, Whalen JD, Ribeiro-Oliveira A, Campbell JD. Economic and clinical burden of comorbidities among patients with acromegaly. Growth Horm. IGF Res. 59, 101389 (2021).
15.
Vargas-Ortega G, Romero-Gameros CA, Rendón-Macias ME et al. Risk factors associated with thyroid nodular disease in acromegalic patients: a case-cohort study in a tertiary center. Growth Horm. IGF Res. 60–61, 101431 (2021).
16.
Tiemensma J, Biermasz NR, van der Mast RC et al. Increased psychopathology and maladaptive personality traits, but normal cognitive functioning, in patients after long-term cure of acromegaly. J. Clin. Endocrinol. Metab. 95(12), E392–E402 (2010).
17.
FDA. “Sandostatin LAR Depot, drug label” (2024). Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/021008Orig1s047lbl.pdf
18.
FDA. “Somatuline Depot (lanreotide) drug label” (2014). Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022074s011lbl.pdf
19.
Novartis Pharmaceuticals Corporation. Sandostatin LAR® Depot (octreotide acetate for injectable suspension) [prescribing information] (2019). Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021008s043lbl.pdf
20.
Ribeiro-Oliveira A, Brook RA, Munoz KA et al. Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care. J. Med. Econ 24(1), 432–439 (2021).
21.
Placzek H, Xu Y, Mu Y, Begelman SM, Fisher M. Clinical and economic burden of commercially insured patients with acromegaly in the United States: a retrospective analysis. J. Manag. Care Spec. Pharm. 21(12), 1106–1112 (2015).
22.
Fleseriu M, Molitch M, Dreval A et al. Disease and treatment-related burden in patients with acromegaly who are biochemically controlled on injectable somatostatin receptor ligands. Front. Endocrinol. 12, 627711 (2021).
• Reports high disease and treatment burden among patients who are biochemically controlled with the use of injections. Patients experienced gastrointestinal symptoms, pain at the injection site and interference with daily life.
23.
Geer EB, Sisco J, Adelman DT et al. Patient reported outcome data from acromegaly patients treated with injectable somatostatin receptor ligands (SRLs) in routine clinical practice. BMC Endocr. Disord. 20(1), 117 (2020).
• This study used a one-time online survey of patients with acromegaly who were either on a stable dose of octreotide or lanreotide for at least 12-months. Most patients reported experiencing constant symptoms (e.g., tiredness, carpal tunnel syndrome, snoring and excessive sweating), while fewer patients reported experiencing symptoms only at the end of the injection cycle.
24.
Strasburger CJ, Karavitaki N, Störmann S et al. Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly. Eur. J. Endocrinol. 174(3), 355–362 (2016).
25.
Kyriakakis N, Seejore K, Hanafy A, Murray RD. Management of persistent acromegaly following primary therapy: the current landscape in the UK. Endocrinol. Diabetes Metab. 3(3), e00158 (2020).
26.
Ogedegbe OJ, Cheema AY, Khan MA et al. A comprehensive review of four clinical practice guidelines of acromegaly. Cureus 14(9), e28722 (2022).
27.
Mattar P, Alves Martins MR, Abucham J. Short- and long-term efficacy of combined cabergoline and octreotide treatment in controlling IGF-I levels in acromegaly. Neuroendocrinology 92(2), 120–127 (2010).
28.
Kizilgul M, Duger H, Nasiroglu NI et al. Efficacy of cabergoline add-on therapy in patients with acromegaly resistance to somatostatin analogs treatment and the review of literature. Arch. Endocrinol. Metab. 66(3), 278–285 (2022).
29.
Vilar L, Azevedo MF, Naves LA et al. Role of the addition of cabergoline to the management of acromegalic patients resistant to longterm treatment with octreotide LAR. Pituitary 14(2), 148–156 (2010).
30.
Suda K, Inoshita N, Iguchi G et al. Efficacy of combined octreotide and cabergoline treatment in patients with acromegaly: a retrospective clinical study and review of the literature. Endocr. J. 60(4), 507–515 (2013).
31.
Chuang C-C, Bhurke S, Chen S-Y, Dinet J, Brulais S, Gabriel S. Treatment patterns and economic burden in patients treated for acromegaly in the USA. Drugs - Real World Outcomes 2(3), 299–309 (2015).
32.
Lim EM, Pullan P. Biochemical assessment and long-term monitoring in patients with acromegaly: statement from a joint consensus conference of the growth hormone research society and the pituitary society. Clin. Biochem. Rev. 26(2), 41–43 (2005).
33.
U.S. Bureau of Labor Statistics. “CPI inflation calculator - consumer price index for all urban consumers (CPI-U)” (2024). Available from: https://www.bls.gov/data/inflation_calculator.htm
34.
Donabedian A. The quality of care: how can it be assessed? JAMA 260(12), 1743–1748 (1988).
35.
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press (US), DC, USA (2001).
Information & Authors
Information
Published In
Copyright
© 2025 The authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 10 May 2025
Accepted: 9 July 2025
Published online: 17 July 2025
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Dosing patterns, healthcare resource utilization and costs among acromegaly patients who consistently use lanreotide and injectable octreotide. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0070
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Hayri Bostan, Iris C. M. Pelsma, Nienke R. Biermasz, Sex-related differences in healthcare utilization and costs among patients with pituitary adenomas, Pituitary, 10.1007/s11102-026-01638-0, 29, 1, (2026).