Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas.
BackgroundFew studies address the cost of treating prolactinomas. We performed a cost-utility analysis of surgical versus medical treatment for prolactinomas.Materials and MethodsWe 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.ResultsAverage 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%.ConclusionOur 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.
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States; Center for Healthcare Value, University of California at San Francisco, San Francisco, California, United States.
Corinna C
CC
Zygourakis
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
Brandon S
BS
Imber
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States.
Rebecca
R
Chen
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States.
Seunggu J
SJ
Han
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States.
Lewis
L
Blevins
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States; Department of Epidemiology and Statistics, University of California at San Francisco, San Francisco, California, United States.
Annette
A
Molinaro
Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States.
James G
JG
Kahn
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States.
Manish K
MK
Aghi
cost; cost-effectiveness; cost-utility analysis; dopamine agonist; pituitary tumor; prolactinoma; transsphenoidal surgery