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J Neurol Surg B Skull Base 2017; 78(02): 125-131
DOI: 10.1055/s-0036-1592193
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Cost-Effectiveness Analysis of Surgical versus Medical Treatment of Prolactinomas

Corinna C. Zygourakis
1   Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States
2   Center for Healthcare Value, University of California at San Francisco, San Francisco, California, United States
,
Brandon S. Imber
3   Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
,
Rebecca Chen
1   Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States
,
Seunggu J. Han
1   Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States
,
Lewis Blevins
1   Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States
,
Annette Molinaro
1   Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States
4   Department of Epidemiology and Statistics, University of California at San Francisco, San Francisco, California, United States
,
James G. Kahn
5   Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, United States
,
Manish K. Aghi
1   Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, United States
› Author Affiliations
Further Information

Publication History

28 March 2016

02 August 2016

Publication Date:
27 September 2016 (online)

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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.

Keywords

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

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