A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas.
Glob Reg Health Technol Assess
; 11: 1-16, 2024.
Article
in En
| MEDLINE
| ID: mdl-38230389
ABSTRACT
Background:
Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma.Objective:
This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies.Methods:
The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost.Results:
The average cost of the first year of treatment was 2,558.91 and 3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were 798.13 and 1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of 3,201.15 compared to bromocriptine, based on a willingness-to-pay of 40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of 44,846.64. Considering a willingness-to-pay of 40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that.Conclusions:
Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.
Full text:
1
Database:
MEDLINE
Type of study:
Guideline
Language:
En
Year:
2024
Type:
Article