Innovative Approaches to Improve the Success of Pituitary Surgery in Cushing's Disease: A Cost-Effectiveness Perspective.

OBJECTIVE

Patients require additional treatment when pituitary surgery for Cushing's disease is unsuccessful. Exciting innovations in pituitary surgery bring hope for achieving better outcomes. Quantifying the potential value of these innovations using early health economic modelling can provide guidance throughout their development. The aim of this study was to explore the conditions for success of these innovations using cost-effectiveness analyses.

DESIGN

The model consists of a decision tree and state-transition model with a 10-year time horizon.

PATIENTS

The model simulates the clinical management of patients with Cushing's disease and pituitary surgery as primary treatment.

MEASUREMENTS

Model input was derived from literature and expert opinion. Model outcomes were incremental healthcare costs and incremental quality-adjusted life-years (QALY). We performed scenario analyses, including a headroom and threshold analysis, to determine the maximum innovation price for cost-effectiveness. Probabilistic sensitivity analysis and one-way sensitivity analyses were performed to address the impact of uncertainty on outcome parameters.

RESULTS

The headroom analysis showed that per patient 0.028 QALYs could be gained and 2082 euros could be saved over 10 years. With a willingness to pay of 80,000 euros, the maximum price of an innovation is 4288 euros (95% CI: 3377-5181) to reach cost-effectiveness. Sensitivity analyses showed that utility values mainly determined cost-effectiveness.

CONCLUSION

Our early health economic model exploring the conditions for success of innovations in pituitary surgery shows room for improvement, but also the importance of accurate health-related quality of life data to assess the economic value of innovations in individuals with CD.