TY - JOUR
T1 - Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas
AU - Zygourakis, Corinna C.
AU - Imber, Brandon S.
AU - Chen, Rebecca
AU - Han, Seunggu J.
AU - Blevins, Lewis
AU - Molinaro, Annette
AU - Kahn, James G.
AU - Aghi, Manish K.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background Few studies address the cost of treating prolactinomas. We performed a cost-utility analysis of surgical versus medical treatment for prolactinomas. Materials and Methods We determined total hospital costs for surgically and medically treated prolactinoma patients. Decision-tree analysis was performed to determine which treatment produced the highest quality-adjusted life years (QALYs). Outcome data were derived from published studies. Results Average total costs for surgical patients were 19,224 (± 18,920). Average cost for the first year of bromocriptine or cabergoline treatment was 3,935 and 6,042, with 2,622 and 4,729 for each additional treatment year. For a patient diagnosed with prolactinoma at 40 years of age, surgery has the lowest lifetime cost (40,473), followed by bromocriptine (41,601) and cabergoline (70,696). Surgery also appears to generate high health state utility and thus more QALYs. In sensitivity analyses, surgery appears to be a cost-effective treatment option for prolactinomas across a range of ages, medical/surgical costs, and medical/surgical response rates, except when surgical cure rates are ≤ 30%. Conclusion Our single institution analysis suggests that surgery may be a more cost-effective treatment for prolactinomas than medical management for a range of patient ages, costs, and response rates. Direct empirical comparison of QALYs for different treatment strategies is needed to confirm these findings.
AB - Background Few studies address the cost of treating prolactinomas. We performed a cost-utility analysis of surgical versus medical treatment for prolactinomas. Materials and Methods We determined total hospital costs for surgically and medically treated prolactinoma patients. Decision-tree analysis was performed to determine which treatment produced the highest quality-adjusted life years (QALYs). Outcome data were derived from published studies. Results Average total costs for surgical patients were 19,224 (± 18,920). Average cost for the first year of bromocriptine or cabergoline treatment was 3,935 and 6,042, with 2,622 and 4,729 for each additional treatment year. For a patient diagnosed with prolactinoma at 40 years of age, surgery has the lowest lifetime cost (40,473), followed by bromocriptine (41,601) and cabergoline (70,696). Surgery also appears to generate high health state utility and thus more QALYs. In sensitivity analyses, surgery appears to be a cost-effective treatment option for prolactinomas across a range of ages, medical/surgical costs, and medical/surgical response rates, except when surgical cure rates are ≤ 30%. Conclusion Our single institution analysis suggests that surgery may be a more cost-effective treatment for prolactinomas than medical management for a range of patient ages, costs, and response rates. Direct empirical comparison of QALYs for different treatment strategies is needed to confirm these findings.
KW - cost
KW - cost-effectiveness
KW - cost-utility analysis
KW - dopamine agonist
KW - pituitary tumor
KW - prolactinoma
KW - transsphenoidal surgery
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U2 - 10.1055/s-0036-1592193
DO - 10.1055/s-0036-1592193
M3 - Article
AN - SCOPUS:84988945966
SN - 2193-634X
VL - 78
SP - 125
EP - 131
JO - Journal of Neurological Surgery, Part B: Skull Base
JF - Journal of Neurological Surgery, Part B: Skull Base
IS - 2
ER -