A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas.
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Basile Michele, Valentini Ilaria, Attanasio Roberto, Cozzi Renato, Persichetti Agnese, Samperi Irene, Scoppola Alessandro, Auriemma Renata Simona, De Menis Ernesto, Esposito Felice, Ferrante Emanuele, Iatì Giuseppe, Mazzatenta Diego, Poggi Maurizio, Rudà Roberta, Tortora Fabio, Cruciani Fabio, Mitrova Zuzana, Saulle Rosella, Vecchi Simona, Cappabianca Paolo, Paoletta Agostino, Bozzao Alessandro, Caputo Marco, Doglietto Francesco, Ferraù Francesco, Lania Andrea Gerardo, Laureti Stefano, Lello Stefano, Locatelli Davide, Maffei Pietro, Minniti Giuseppe, Peri Alessandro, Ruini Chiara, Settanni Fabio, Silvani Antonio, Veronese Nadia, Grimaldi Franco, Papini Enrico, Cicchetti Americo
Аннотация
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.