Amanda Speller

Objectives: To analyze obstetric ultrasound utilization and expenditures per live birth delivery among the commercially insured from 2016 to 2022 and present updated trends and variation in use by type of ultrasound and across subgroups. Methods: In this retrospective United States‐based cohort study, obstetric ultrasound utilization and expenditures during pregnancy were measured for a cohort of all deliveries with at least 28‐week gestation that resulted in a live birth between January 1, 2017 and December 31, 2022, using the Health Care Cost Institute commercial claims database. We report utilization trends and the clinical and sociodemographic factors correlated with utilization using descriptive statistics and negative binomial regression. Results: In our sample of 1,731,823 pregnancies, there were an average of 5.3 (SD ± 3.9) claims for obstetric ultrasounds per live birth delivery. After adjusting for covariates, the number of ultrasounds per live birth increased by 8.3% and inflation‐adjusted spending for these ultrasounds increased 5.6% over the 7‐year study period ( p < .001); though utilization decreased during the COVID‐19 pandemic in 2020. Follow‐up ultrasound (CPT 76816) was the fastest growing procedure. Conclusion: Obstetric ultrasound utilization and expenditures increased from 2016 to 2022. Information on the variation in patterns and trends related to obstetric ultrasound use may assist policy makers in their assessment of resource utilization and approach to reimbursement design, such as obstetric bundled payments.

Aim: The aim of this study was to describe treatment patterns among patients with acromegaly who are newly treated with acromegaly medical therapy. Materials & methods: Data from IQVIA Pharmetrics Plus ^® Database from 1 January 2013 to 30 June 2023 were used to identify patients with acromegaly who started a new acromegaly medical therapy and observe their treatment patterns. Patients were required to have at least 12 months of data without any acromegaly therapy (medication or surgery) prior to the index date and at least 6 months of follow-up. Comorbidities were measured during the baseline period. Adherence, persistence, medication and switching were measured during follow-up. Results: A total of 453 patients with acromegaly who were newly treated with acromegaly medical therapy and had no evidence of acromegaly therapy for at least 12 months were identified. Among these patients, 46.1% (n = 206) were treated with cabergoline as their index treatment, 24.5% (n = 111) with injectable octreotide, 15.0% (n = 68) with lanreotide, 5.5% (n = 25) with bromocriptine, 4.9% (n = 22) with pegvisomant, 2.2% (n = 10) with pasireotide, 1.1% (n = 5) with oral octreotide, 0.4% (n = 2) with cabergoline + octreotide, and 0.2% (n = 1) with cabergoline + lanreotide. By the end of the follow-up period, 54.3% (n = 246) were not on any treatment, 19.6% (n = 89) remained on the index treatment, and the remaining 26.0% (n = 118) switched to another treatment. Conclusion: This study contributed to the growing evidence that patients with acromegaly are not well-served by current therapeutic options, as indicated by high rates of treatment discontinuation, switching and add-on therapy. However, treatment switching and add-on therapy represent ongoing efforts to optimize patient care toward more effective and tolerable treatments. Expanded treatment options may serve an unmet need in this patient population.

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.

Aim: Recent evidence regarding the healthcare resource utilization (HCRU) and associated costs of acromegaly is limited. Materials & methods: This retrospective, cross-sectional administrative claims analysis (IQVIA Pharmetrics Plus ^® ) identified patients (≥18 years) with acromegaly between 1 January 2017 and 30 June 2022. HCRU and costs over 1 year were compared in patients with acromegaly and matched patients without acromegaly (age, sex, insurance type, year). Among patients with acromegaly, annual total healthcare costs of comorbidities and procedures consistent with high-risk comorbidities were reported. Costs were adjusted to 2023 USD. Results: Among 2289 patients with acromegaly and 2289 matched patients without acromegaly, mean age was 49.8 years and 51.6% were female. Patients with acromegaly had a significantly (p < 0.001) higher comorbidity burden than patients without acromegaly. A significantly (p < 0.001) greater proportion of patients with acromegaly versus patients without acromegaly had inpatient hospitalizations (20.1 vs 4.9%) and emergency department visits (23.9 vs 15.7%). Total mean healthcare costs were also significantly higher for patients with acromegaly than patients without acromegaly ($51,888 vs $10,601). The majority of acromegaly-related healthcare costs ($30,985) were attributable to acromegaly therapy ($25,895). Hypertension (42.8%) was the most common high-risk comorbidity associated with acromegaly. The costliest high-risk comorbidity was congestive heart failure, with a mean cost difference of $38,123 (p < 0.05) between patients with acromegaly with and without hypertension. Conclusion: Patients with acromegaly had higher HCRU and costs than matched patients without acromegaly, and the presence of acromegaly with high-risk comorbidities was associated with a substantial HCRU and cost burden. This high burden of illness may be alleviated with better disease control.

Aim: To compare healthcare resource utilization (HCRU) and costs between older adults with and without acromegaly. Materials & methods: Using 2017–2022 100% Medicare Research Identifiable Files, we identified beneficiaries (≥65 years) with prevalent cases of acromegaly. A randomly selected claim with an acromegaly diagnosis was the index date. Beneficiaries were required to have continuous enrollment in Medicare fee-for-service and Part D for the 1-year post-index period (observation period). Beneficiaries with acromegaly were matched 1:1 (age, sex, race, US geographic region) to acromegaly-free beneficiaries (reference group). The beneficiaries in the reference group were assigned the same index date as their matched beneficiary with acromegaly and met the same enrollment criteria. Outcomes of interest, measured during the observation period, included all-cause and acromegaly-related HCRU and costs (adjusted to 2022 US dollars). Results: We identified 3491 beneficiaries with acromegaly and 3491 without acromegaly. The mean age was 73.1 years and the majority of beneficiaries were female and non-Hispanic White. Beneficiaries with acromegaly had more HCRU than those without acromegaly, including a greater proportion with hospitalizations (27.6 vs 14.9%), ED visits (31.8 vs 22.8%), use of skilled nursing facility care (7.3 vs 3.5%) and home health agency visits (18.1 vs 8.4%) (p < 0.001 for all). Total all-cause healthcare costs were higher among beneficiaries with acromegaly versus those without acromegaly ($45,830 vs $18,922, p < 0.001). The majority of beneficiaries with acromegaly (69.6%) did not have evidence of acromegaly treatment. Conclusion: Medicare beneficiaries with acromegaly have substantial HCRU and costs compared with controls without acromegaly; this indicates a high burden of illness which may be lessened by new and effective therapeutic options for those with acromegaly.