Supplementary material: Dosing patterns, healthcare resource utilization and costs among acromegaly patients who consistently use lanreotide and injectable octreotide

<b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>'</b><b>Dosing patterns, healthcare resource utilization and costs among acromegaly patients who consistently use lanreotide and injectable octreotide</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Table A1: </b>List of CPT and ICD codes for hypophysectomy and stereotactic radiosurgery<b>Table A2: </b>List of ICD-9 codes and ICD-10 codes for comorbidities of interest<b>Table A3: </b>All-cause total healthcare costs among patients who received &gt; 14 injections<b>Aim: </b>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. <b>Materials &amp; methods:</b> 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. <b>Results: </b>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 &lt; 0.001) or lanreotide ($143,975 vs $96,518, p &lt; 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. <b>Conclusion:</b> 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.<br>

本文为发表于《比较效果研究杂志》（*Journal of Comparative Effectiveness Research*）的论文《持续使用兰瑞肽与注射用奥曲肽的肢端肥大症患者的给药模式、医疗资源利用与成本》的同行评议补充材料。
表A1：垂体切除术与立体定向放射外科手术的当前操作术语编码（Current Procedural Terminology, CPT）及国际疾病分类（International Classification of Diseases, ICD）编码列表
表A2：目标合并症的国际疾病分类第9版（ICD-9）与第10版（ICD-10）编码列表
表A3：接受注射次数＞14次的患者的全因总医疗成本
研究目的：在美国，兰瑞肽与注射用奥曲肽是治疗肢端肥大症的常用药物。多数患者的推荐给药方案为每4周注射1次，即每年给药13次。本研究旨在量化给药次数超出标准推荐方案的患者占比，并评估高频（high frequency, HF）用药是否与更高的医疗资源消耗及成本相关。
材料与方法：本研究使用2013年1月1日至2023年6月30日期间的艾昆纬（IQVIA）Pharmetrics Plus数据库数据，针对至少接受2年注射用奥曲肽或兰瑞肽治疗的肢端肥大症患者开展回顾性观察研究。本研究的主要结局指标为注射次数与高频用药情况。高频用药定义为在1年观察期内接受注射次数超过13次。
研究结果：本研究共纳入420名肢端肥大症患者，其中接受注射用奥曲肽治疗者250例、兰瑞肽治疗者170例，中位治疗时长为4年。注射用奥曲肽使用者与兰瑞肽使用者的高频用药占比分别为32.4%与30.6%。在1年观察期内，接受注射用奥曲肽治疗的高频用药患者的平均总医疗成本显著高于非高频用药患者（130238美元 vs 85964美元，p＜0.001）；兰瑞肽治疗组的高频用药患者平均总医疗成本同样显著高于非高频用药患者（143975美元 vs 96518美元，p＜0.001）。此外，10%的高频用药患者年医疗成本达238070美元至281167美元甚至更高。按单次注射成本计算，高频用药患者每年需额外承担12803美元至13480美元的注射相关费用。
研究结论：在持续接受治疗的肢端肥大症患者中，近三分之一为兰瑞肽或注射用奥曲肽的高频用药者。高频用药带来的经济负担较重。鉴于超比例患者的给药方案超出获批药品说明书的推荐要求，亟需对新型治疗方案开展进一步评估。