title: Health care resource use and costs among patients with cushing disease.
abstract: OBJECTIVE
  To assess health care costs associated with Cushing disease and to determine changes in overall and comorbidity-related costs after surgical treatment.
  
  
  METHODS
  In this retrospective cohort study, patients with Cushing disease were identified from insurance claims databases by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for Cushing syndrome (255.0) and either benign pituitary adenomas (227.3) or hypophysectomy (07.6×) between 2004 and 2008. Each patient with Cushing disease was age- and sex-matched with 4 patients with nonfunctioning pituitary adenomas and 10 population control subjects. Comorbid conditions and annual direct health care costs were assessed within each calendar year. Postoperative changes in health care costs and comorbidity-related costs were compared between patients presumed to be in remission and those with presumed persistent disease.
  
  
  RESULTS
  Of 877 identified patients with Cushing disease, 79% were female and the average age was 43.4 years. Hypertension, diabetes mellitus, and hyperlipidemia were more common among patients with Cushing disease than in patients with nonfunctioning pituitary adenomas or in control patients (P<.01). For every calendar year studied, patients with Cushing disease had significantly higher total health care costs (2008: $26 440 [Cushing disease] vs $13 708 [nonfunctioning pituitary adenomas] vs $5954 [population control], P<.01). Annual outpatient costs decreased significantly for patients in remission after surgery, and there was a trend towards improvement in overall disease-related costs with remission. A significant increase in postoperative health care costs was observed in those patients not in remission.
  
  
  CONCLUSIONS
  Patients with Cushing disease had more comorbidities than patients with nonfunctioning pituitary adenomas or control patients and incurred significantly higher annual health care costs; these costs decreased after successful surgery and increased after unsuccessful surgery.
authors: Neuroendocrine Clinical Center, Massachusetts General Hospital, Boston, Massachusetts, USA. BSwearingen@partners.org
authors: Brooke
authors: B
authors: Swearingen
authors: Ning
authors: N
authors: Wu
authors: Shih-Yin
authors: SY
authors: Chen
authors: Sonia
authors: S
authors: Pulgar
authors: Beverly M K
authors: BM
authors: Biller
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000191:economics*; D012189:Retrospective Studies