Download PDF
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)

    Permissions and Reprints

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
 

  • References

  • 1 Colao A, Savastano S. Medical treatment of prolactinomas. Nat Rev Endocrinol 2011; 7 (5) 267-278
    CrossrefPubMedGoogle Scholar
  • 2 Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev 2006; 27 (5) 485
    CrossrefPubMedGoogle Scholar
  • 3 Couldwell WT, Rovit RL, Weiss MH. Role of surgery in the treatment of microprolactinomas. Neurosurg Clin N Am 2003; 14 (1) 89-92 , vii
    CrossrefPubMedGoogle Scholar
  • 4 Liu JK, Couldwell WT. Contemporary management of prolactinomas. Neurosurg Focus 2004; 16 (4) E2
    PubMedGoogle Scholar
  • 5 Oh MC, Kunwar S, Blevins L, Aghi MK. Medical versus surgical management of prolactinomas. Neurosurg Clin N Am 2012; 23 (4) 669-678
    CrossrefPubMedGoogle Scholar
  • 6 Olafsdottir A, Schlechte J. Management of resistant prolactinomas. Nat Clin Pract Endocrinol Metab 2006; 2 (10) 552-561
    CrossrefPubMedGoogle Scholar
  • 7 Sheplan Olsen LJ, Robles Irizarry L, Chao ST , et al. Radiotherapy for prolactin-secreting pituitary tumors. Pituitary 2012; 15 (2) 135-145
    CrossrefPubMedGoogle Scholar
  • 8 Arduc A, Gokay F, Isik S , et al. Retrospective comparison of cabergoline and bromocriptine effects in hyperprolactinemia: a single center experience. J Endocrinol Invest 2015; 38 (4) 447-453
    CrossrefPubMedGoogle Scholar
  • 9 Anagnostis P, Adamidou F, Polyzos SA, Efstathiadou Z, Karathanassi E, Kita M. Long term follow-up of patients with prolactinomas and outcome of dopamine agonist withdrawal: a single center experience. Pituitary 2012; 15 (1) 25-29
    CrossrefPubMedGoogle Scholar
  • 10 Barber TM, Kenkre J, Garnett C, Scott RV, Byrne JV, Wass JAH. Recurrence of hyperprolactinaemia following discontinuation of dopamine agonist therapy in patients with prolactinoma occurs commonly especially in macroprolactinoma. Clin Endocrinol (Oxf) 2011; 75 (6) 819-824
    CrossrefPubMedGoogle Scholar
  • 11 Dekkers OM, Lagro J, Burman P, Jørgensen JO, Romijn JA, Pereira AM. Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J Clin Endocrinol Metab 2010; 95 (1) 43-51
    CrossrefPubMedGoogle Scholar
  • 12 Loyo-Varela M, Herrada-Pineda T, Revilla-Pacheco F, Manrique-Guzman S. Pituitary tumor surgery: review of 3004 cases. World Neurosurg 2013; 79 (2) 331-336
    CrossrefPubMedGoogle Scholar
  • 13 Roelfsema F, Biermasz NR, Pereira AM. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. Pituitary 2012; 15 (1) 71-83
    CrossrefPubMedGoogle Scholar
  • 14 Marko NF, LaSota E, Hamrahian AH, Weil RJ. Comparative effectiveness review of treatment options for pituitary microadenomas in acromegaly. J Neurosurg 2012; 117 (3) 522-538
    CrossrefPubMedGoogle Scholar
  • 15 Turner HE, Adams CB, Wass JA. Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?. Eur J Endocrinol 1999; 140 (1) 43-47
    CrossrefPubMedGoogle Scholar
  • 16 Wilson LS, Shin JL, Ezzat S. Longitudinal assessment of economic burden and clinical outcomes in acromegaly. Endocr Pract 2001; 7 (3) 170-180
    CrossrefPubMedGoogle Scholar
  • 17 Zhen J-R, Yu Q, Zhang Y-H, Ma W-B, Lin S-Q. [Cost-effectiveness analysis of two therapeutic methods for prolactinoma]. Zhonghua Fu Chan Ke Za Zhi 2008; 43 (4) 257-261
    PubMedGoogle Scholar
  • 18 Jethwa PR, Patel TD, Hajart AF, Eloy JA, Couldwell WT, Liu JK. Cost-effectiveness analysis of microscopic and endoscopic transsphenoidal surgery versus medical therapy in the management of microprolactinoma in the United States. World Neurosurg 2016; 87: 65-76
    CrossrefPubMedGoogle Scholar
  • 19 Husereau D, Drummond M, Petrou S , et al. Consolidated Health Economic Reporting Evaluation Standard (CHEERS) Statement. BMJ 2013; 346: 231-250
    PubMedGoogle Scholar
  • 20 Centers for Disease Control and Prevention. FASTSTATS - Life expectancy. www.cdc.gov/nchs/fastats/life-expectancy.htm . Accessed September 13, 2016
    PubMedGoogle Scholar
  • 21 Cesar de Oliveira Naliato E, Dutra Violante AH, Caldas D , et al. Quality of life in women with microprolactinoma treated with dopamine agonists. Pituitary 2008; 11 (3) 247-254
    CrossrefPubMedGoogle Scholar
  • 22 Ritvonen E, Karppinen A, Sintonen H , et al. Normal long-term health-related quality of life can be achieved in patients with functional pituitary adenomas having surgery as primary treatment. Clin Endocrinol (Oxf) 2015; 82 (3) 412-421
    CrossrefPubMedGoogle Scholar
  • 23 Ara R, Brazier J. Deriving an algorithm to convert the eight mean SF-36 dimension scores into a mean EQ-5D preference-based score from published studies (where patient level data are not available). Value Health 2008; 11 (7) 1131-1143
    CrossrefPubMedGoogle Scholar
  • 24 Qu X, Wang M, Wang G , et al. Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases. Eur J Endocrinol 2011; 164 (4) 499-504
    CrossrefPubMedGoogle Scholar
  • 25 Sughrue ME, Chang EF, Tyrell JB, Kunwar S, Wilson CB, Blevins Jr LS. Pre-operative dopamine agonist therapy improves post-operative tumor control following prolactinoma resection. Pituitary 2009; 12 (3) 158-164
    CrossrefPubMedGoogle Scholar
  • 26 Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery 1999; 44 (2) 254-261 , discussion 261–263
    CrossrefPubMedGoogle Scholar
  • 27 Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF ; Cabergoline Comparative Study Group. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. N Engl J Med 1994; 331 (14) 904-909
    CrossrefPubMedGoogle Scholar
  • 28 Kreutzer J, Buslei R, Wallaschofski H , et al. Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur J Endocrinol 2008; 158 (1) 11-18
    CrossrefPubMedGoogle Scholar
  • 29 Hawthorne G, Richardson J, Day NA. A comparison of the assessment of quality of life (AQoL) with four other generic utility instruments. Ann Med 2001; 33 (5) 358-370
    CrossrefPubMedGoogle Scholar