Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas

Corinna C. Zygourakis, Brandon S. Imber, Rebecca Chen, Seunggu (Jude) Han, Lewis Blevins, Annette Molinaro, James G. Kahn, Manish K. Aghi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)125-131
Number of pages7
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume78
Issue number2
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

Fingerprint

Prolactinoma
Cost-Benefit Analysis
Costs and Cost Analysis
Quality-Adjusted Life Years
Bromocriptine
Health Care Costs
Therapeutics
Decision Trees
Decision Support Techniques
Hospital Costs
Health

Keywords

  • cost
  • cost-effectiveness
  • cost-utility analysis
  • dopamine agonist
  • pituitary tumor
  • prolactinoma
  • transsphenoidal surgery

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas. / Zygourakis, Corinna C.; Imber, Brandon S.; Chen, Rebecca; Han, Seunggu (Jude); Blevins, Lewis; Molinaro, Annette; Kahn, James G.; Aghi, Manish K.

In: Journal of Neurological Surgery, Part B: Skull Base, Vol. 78, No. 2, 01.04.2017, p. 125-131.

Research output: Contribution to journalArticle

Zygourakis, CC, Imber, BS, Chen, R, Han, SJ, Blevins, L, Molinaro, A, Kahn, JG & Aghi, MK 2017, 'Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas', Journal of Neurological Surgery, Part B: Skull Base, vol. 78, no. 2, pp. 125-131. https://doi.org/10.1055/s-0036-1592193
Zygourakis, Corinna C. ; Imber, Brandon S. ; Chen, Rebecca ; Han, Seunggu (Jude) ; Blevins, Lewis ; Molinaro, Annette ; Kahn, James G. ; Aghi, Manish K. / Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas. In: Journal of Neurological Surgery, Part B: Skull Base. 2017 ; Vol. 78, No. 2. pp. 125-131.
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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.

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