Economic evaluation of pegvisomanto for the treatment of patients with acromegaly with an inadequate response to a maximal dose of octreotide (alone or combined) in the context of the Unified Health System

Abstract

Introduction: Scientific evidences indicate that PEG is configured as effective and safe treatment for patients with acromegaly with inadequate response to maximal dose of octreotide LAR (40 mg 28/28 days). Objectives: Evaluate the cost-effectiveness and budget impact of pegvisomanto (PEG) for the treatment of patients with acromegaly inadequate response to maximal dose of octreotide LAR from the perspective of the Health System. Methods: Economic evaluation was performed using a model of the decision tree associated with the Markov model, employing known clinical data of patients with uncontrolled acromegaly and direct medical costs of treating and complications. For incremental budget impact analysis was used methodology as recommended by the Guidelines of the Ministry of Health. Results: The results indicate that PEG is the dominant technology for the analyzed population, because the patients have better clinical response and lower expenses manager. It is estimated savings of 23,55% compared to the reference scenario, if considered therapeutic change of all patients in use octreotide LAR with doses greater than 40 mg 28/28 days for PEG 15 mg/Day (70% of patients) and 20 mg/Day (30% of them), representing R$ 10,53 million in monetary terms. The percentage of savings may vary depending on the therapeutic transition scenario adopted (sensitivity analysis). Conclusions: PEG is an effective option in the therapeutic arsenal of acromegaly in patients that does not achieve biochemical control with octreotida LAR and can generate savings up to 0.215% compared to the resources allocated to the Specializing Pharmaceutical Services Component (CEAF) for the year 2014.