Gestione dell’acromegalia in un centro di riferimento: valutazione dei costi diretti di malattia e gestione del paziente durante la pandemia da SARS-CoV-2

Background. Acromegaly is a severe chronic endocrine disease. Achieving biochemical control often needs a multimodal treatment approach, including prolonged medical treatment. The global pandemic due to Coronavirus Disease (COVID-19) represents the toughest challenge faced by the healthcare systems in the modern history and affected the management of many chronic diseases, such as acromegaly. Aim of the study is to evaluate the burden of treatment direct costs with respect to the different therapeutic strategies, disease control, and follow-up length. Besides, it is to report the impact of the pandemic in our Unit of Endocrinology during the 2020. Methods. Single center retrospective study on 73 patients referred to our center between 1st January 2002 and 31st December 2018. Costs of acromegaly treatments were computed based on a detailed revision of patients’ clinical charts. Finally, we evaluated the number of outpatient visits and the disease control rate in 2019 and 2020 of as many patients actively followed. Results. Median total treatment cost/patient was €47393 during the entire follow-up (8.7 years), while median treatment cost/patient/year was €6811. The majority of patients received medical therapy (71/73, 97.3%). Median cost for first-line medical treatment (first-generation somatostatin receptor ligands) was lower compared to second-line treatments (pegvisomant monotherapy or combination therapies), considering both total (€22825 vs €76140; p < 0.001), and yearly cost/patient (€4927 vs €9161; p < 0.001). Sixty patients (82.2%) reached biochemical control at last follow-up (IGF-1 ≤ 1 x upper limit of normality range (ULN)). The yearly cost/patient was comparable between controlled and uncontrolled patients (€6936 vs €6688; p = 0.829). Follow-up duration was significantly longer in controlled patients compared to the uncontrolled ones (8.7 vs 3.5 years; p = 0.019). Finally, we compared data between 31th December 2019 and 31th December 2020. A total of 177 on-site visits were performed in 2019 (median: 2 visits/patient/year), while this number felt down to 118 evaluations in 2020 (median: 1 visit/patient/ year). This 33% reduction of on-site evaluations was partially mitigated performing 21 phone visits. Looking to the patients’ biochemical control, we found that median IGF-1 levels in 2019 were superimposable compared to those observed at the end of 2020 (IGF-1 xULN, median (IQR): 0.735 vs 0.740, p = 0.339). Therefore, we observed that the percentage of biochemically controlled patients did not change significantly between 2019 and 2020, ranging from 75% to 79%. Conclusions. Direct costs for the management of acromegaly have a significant burden on the healthcare systems. However, more than 80% of our patients reached biochemical control using multimodal approaches. Treatment modalities and yearly costs did not significantly differ between controlled and uncontrolled patients, while follow-up length represented a major determinant of biochemical outcome. Cure rate in tertiary centers is high, and patients’ follow-up is usually long enough to build up a strong relationship with the patients, thus improving adherence and persistence to treatment, as well as of self-management. Dealing with a chronic disease has given us the opportunity to mitigate the effects of the pandemic in the short-term.