Shaun J Kilty1,2, Myriam G M Hunink3,4, Lisa Caulley5,6,7, Eline Krijkamp8, Mary-Anne Doyle9,2, Kednapa Thavorn10,11, Fahad Alkherayf2,12, Nick Sahlollbey13, Selina X Dong13, Jason Quinn14, Stephanie Johnson-Obaseki1,2, David Schramm1,2. 1. Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada. 2. The Ottawa Hospital Research Institute, Ottawa, Canada. 3. Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. 4. Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA. 5. Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada. Lic955@mail.harvard.edu. 6. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada. Lic955@mail.harvard.edu. 7. Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. Lic955@mail.harvard.edu. 8. Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. 9. Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada. 10. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada. 11. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 12. Department of Neurosurgery, University of Ottawa, Ottawa, Canada. 13. Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada. 14. Department of Pathology, Dalhousie University, Halifax, Canada.
Abstract
PURPOSE: The objective of this study was to compare the cost-effectiveness of preoperative octreotide therapy followed by surgery versus the standard treatment modality for growth-hormone secreting pituitary adenomas, direct surgery (that is, surgery without preoperative treatment) from a public third-party payer perspective. METHODS: We developed an individual-level state-transition microsimulation model to simulate costs and outcomes associated with preoperative octreotide therapy followed by surgery and direct surgery for patients with growth-hormone secreting pituitary adenomas. Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs [2020 United States (US) Dollars], quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULTS: Under base case assumptions, direct surgery was found to be the dominant strategy as it yielded lower costs and greater health effects (QALYs) compared to preoperative octreotide strategy in the second-order Monte Carlo microsimulation. The ICER was most sensitive to probability of remission following primary therapy and duration of preoperative octreotide therapy. Accounting for joint parameter uncertainty, direct surgery had a higher probability of demonstrating a cost-effective profile compared to preoperative octreotide treatment at 77% compared to 23%, respectively. CONCLUSIONS: Using standard benchmarks for cost-effectiveness in the US ($100,000/QALY), preoperative octreotide therapy followed by surgery may not be cost-effective compared to direct surgery for patients with growth-hormone secreting pituitary adenomas but the result is highly sensitive to initial treatment failure and duration of preoperative treatment.
PURPOSE: The objective of this study was to compare the cost-effectiveness of preoperative octreotide therapy followed by surgery versus the standard treatment modality for growth-hormone secreting pituitary adenomas, direct surgery (that is, surgery without preoperative treatment) from a public third-party payer perspective. METHODS: We developed an individual-level state-transition microsimulation model to simulate costs and outcomes associated with preoperative octreotide therapy followed by surgery and direct surgery for patients with growth-hormone secreting pituitary adenomas. Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs [2020 United States (US) Dollars], quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULTS: Under base case assumptions, direct surgery was found to be the dominant strategy as it yielded lower costs and greater health effects (QALYs) compared to preoperative octreotide strategy in the second-order Monte Carlo microsimulation. The ICER was most sensitive to probability of remission following primary therapy and duration of preoperative octreotide therapy. Accounting for joint parameter uncertainty, direct surgery had a higher probability of demonstrating a cost-effective profile compared to preoperative octreotide treatment at 77% compared to 23%, respectively. CONCLUSIONS: Using standard benchmarks for cost-effectiveness in the US ($100,000/QALY), preoperative octreotide therapy followed by surgery may not be cost-effective compared to direct surgery for patients with growth-hormone secreting pituitary adenomas but the result is highly sensitive to initial treatment failure and duration of preoperative treatment.
Authors: Adrian F Daly; Martine Rixhon; Christelle Adam; Anastasia Dempegioti; Maria A Tichomirowa; Albert Beckers Journal: J Clin Endocrinol Metab Date: 2006-09-12 Impact factor: 5.958
Authors: Maria Fleseriu; Mary E Bodach; Luis M Tumialan; Vivien Bonert; Nelson M Oyesiku; Chirag G Patil; Zachary Litvack; Manish K Aghi; Gabriel Zada Journal: Neurosurgery Date: 2016-10 Impact factor: 4.654