title: Cost-effectiveness of the endoscopic versus microscopic approach for pituitary adenoma resection.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of an endoscopic versus microscopic approach to pituitary adenoma resection.
  
  
  METHODS
  Markov decision tree economic evaluation.
  
  
  METHODS
  An economic evaluation using a Markov decision tree model was performed. The economic perspective was that of the healthcare third-party payer. Effectiveness and probability data were obtained from a single meta-analysis of 38 studies. Costs were obtained from the Healthcare Cost and Utilization Project database and wholesale pharmaceutical pricing. Multiple sensitivity analyses were performed including a probabilistic sensitivity analysis. Comparative treatment groups were: 1) endoscopic approach and 2) microscopic approach to pituitary adenoma resection. The primary outcome was cost per quality-adjusted life year (QALY). The time horizon was 25 years, and costs were discounted at a rate of 3.5%.
  
  
  RESULTS
  The endoscopic approach cost a total of $17,244.63 and produced a total of 24.30 QALYs. The microscopic approach cost a total of $23,756.60 and produced a total of 24.20 QALYs. In the reference case, the endoscopic approach was a dominant intervention (both less costly and more effective); therefore, an incremental cost-effectiveness ratio was not calculated. The sensitivity analysis demonstrated 79% certainty that the endoscopic approach is the cost-effective decision, at a willingness to pay threshold of $50,000 per QALY.
  
  
  CONCLUSIONS
  This economic evaluation suggests that the endoscopic approach is the more cost-effective intervention compared to the microscopic approach for patients requiring a pituitary adenoma resection.
authors.affiliation: Rhinology and Endoscopic Sinus Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.forename: Yves P
authors.initials: YP
authors.lastname: Starreveld
authors.forename: William A
authors.initials: WA
authors.lastname: Vandergrift
authors.forename: Sarfaraz M
authors.initials: SM
authors.lastname: Banglawala
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
mesh_terms: D000236:Adenoma / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004724:Endoscopy / Q000191:economics*; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000191:economics*; D008390:Markov Chains; D008866:Microsurgery / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D019057:Quality-Adjusted Life Years
keywords: Pituitary adenoma; cost utility analysis; cost-effectiveness analysis; economic evaluation; endoscopic; hypophysectomy; microscopic