Zygourakis Corinna C, Imber Brandon S, Chen Rebecca, Han Seunggu J, Blevins Lewis, Molinaro Annette, Kahn James G, Aghi Manish K
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.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
J Neurol Surg B Skull Base. 2017 Apr;78(2):125-131. doi: 10.1055/s-0036-1592193. Epub 2016 Sep 27.
Few studies address the cost of treating prolactinomas. We performed a cost-utility analysis of surgical versus medical treatment for prolactinomas. 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. 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%. 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.
很少有研究涉及泌乳素瘤的治疗成本。我们对泌乳素瘤的手术治疗与药物治疗进行了成本效用分析。我们确定了手术治疗和药物治疗的泌乳素瘤患者的总住院费用。进行决策树分析以确定哪种治疗产生的质量调整生命年（QALY）最高。结果数据来自已发表的研究。手术患者的平均总费用为19,224美元（±18,920美元）。溴隐亭或卡麦角林治疗第一年的平均费用分别为3,935美元和6,042美元，之后每年的费用分别为2,622美元和4,729美元。对于一名40岁被诊断为泌乳素瘤的患者，手术的终身成本最低（40,473美元），其次是溴隐亭（41,601美元）和卡麦角林（70,696美元）。手术似乎也能产生较高的健康状态效用，从而带来更多的QALY。在敏感性分析中，除了手术治愈率≤30%的情况外，在一系列年龄、医疗/手术成本以及医疗/手术缓解率的情况下，手术似乎都是泌乳素瘤具有成本效益的治疗选择。我们的单机构分析表明，对于一系列患者年龄、成本和缓解率而言，手术治疗泌乳素瘤可能比药物治疗更具成本效益。需要对不同治疗策略的QALY进行直接实证比较以证实这些发现。
