Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Eur J Endocrinol. 2023 Jun 7;188(6):477-484. doi: 10.1093/ejendo/lvad057.
Pituitary adenomas and their consequences impact mortality and morbidity. We studied the healthcare costs, survival, and cost-effectiveness of growth hormone (GH) vs no GH replacement in patients with non-functioning pituitary adenoma (NFPA).
A cohort study including all NFPA patients followed from 1987 or the date of diagnosis until the time of death or December 31, 2019, in the Västra Götaland region, Sweden. Data to assess resource use, costs, survival, and cost-effectiveness were collected from patient records and regional/national healthcare registries.
A total of 426 patients with NFPA (274 men) with a follow-up of 13.6 ± 6.8 years (mean ± SD) were included. The total annual healthcare cost was higher in patients receiving GH (€9287) than those without GH (€6770), mainly driven by a higher pharmaceutical cost. Glucocorticoid replacement therapy (P = .02), diabetes insipidus (P = .04), body mass index (BMI) (P < .01), and hypertension (P < .01) were all individually associated with a higher total annual cost. The survival rate was higher in the GH group (HR [hazard ratio] 0.60; P = .01) and reduced in patients with glucocorticoid replacement (HR 2.02; P < .01) or diabetes insipidus (HR 1.67; P = .04). The cost per gained life-year for GH vs no GH replacement was about €37 000.
This healthcare utilization study identified several factors driving the cost of care in NFPA patients, such as GH replacement, adrenal insufficiency, and diabetes insipidus. Life expectancy was increased in those with GH replacement and reduced in patients with adrenal insufficiency and diabetes insipidus.
垂体腺瘤及其并发症会影响死亡率和发病率。我们研究了生长激素（GH）与不进行 GH 替代治疗对无功能性垂体腺瘤（NFPA）患者的医疗保健成本、生存和成本效益。
这是一项队列研究，纳入了 1987 年或诊断日期起在瑞典西约塔兰地区接受随访的所有 NFPA 患者，直至死亡或 2019 年 12 月 31 日。从患者病历和地区/国家医疗保健登记处收集评估资源利用、成本、生存和成本效益的数据。
共纳入 426 例 NFPA 患者（274 例男性），中位随访时间为 13.6±6.8 年。接受 GH 治疗的患者（€9287）的年总医疗保健费用高于未接受 GH 治疗的患者（€6770），主要是由于药物成本较高。糖皮质激素替代治疗（P=0.02）、尿崩症（P=0.04）、体重指数（BMI）（P<0.01）和高血压（P<0.01）均与年总费用较高相关。GH 组的生存率更高（HR [风险比] 0.60；P=0.01），而接受糖皮质激素替代治疗（HR 2.02；P<0.01）或尿崩症（HR 1.67；P=0.04）的患者生存率降低。GH 治疗与不治疗相比，每获得一个生命年的成本约为 37000 欧元。
这项医疗保健利用研究确定了几个影响 NFPA 患者护理成本的因素，如 GH 替代治疗、肾上腺功能不全和尿崩症。接受 GH 替代治疗的患者预期寿命延长，而肾上腺功能不全和尿崩症患者的预期寿命缩短。
