Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas

被引:35
|
作者
Zygourakis, Corinna C. [1 ,2 ]
Imber, Brandon S. [3 ]
Chen, Rebecca [1 ]
Han, Seunggu J. [1 ]
Blevins, Lewis [1 ]
Molinaro, Annette [1 ,4 ]
Kahn, James G. [5 ]
Aghi, Manish K. [1 ]
机构
[1] Univ Calif San Francisco, Dept Neurol Surg, 505 Parnassus Ave,Room M779, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Ctr Healthcare Value, San Francisco, CA 94143 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol, 1275 York Ave, New York, NY 10021 USA
[4] Univ Calif San Francisco, Dept Epidemiol & Stat, San Francisco, CA 94143 USA
[5] Univ Calif San Francisco, Philip R Lee Inst Hlth Policy Studies, San Francisco, CA 94143 USA
关键词
pituitary tumor; prolactinoma; cost; cost-effectiveness; cost-utility analysis; transsphenoidal surgery; dopamine agonist; QUALITY-OF-LIFE; DOPAMINE AGONISTS; TRANSSPHENOIDAL SURGERY; MICROPROLACTINOMA; MANAGEMENT; THERAPY; OUTCOMES;
D O I
10.1055/s-0036-1592193
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:125 / 131
页数:7
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