A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas. in Global & regional health technology assessment / Glob Reg Health Technol Assess. 2024 Jan 9;11:1-16. doi: 10.33393/grhta.2024.2601. eCollection 2024

2024
ASL Novara

Tipo pubblicazione

Journal Article

Autori/Collaboratori (40)Vedi tutti...

Basile M
High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome.
Valentini I
High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome.
Attanasio R
AME Scientific Committee, Milan.

et alii...

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.

Accesso banca dati bibliografica

PMID : 38230389

DOI : 10.33393/grhta.2024.2601

Keywords

Bromocriptine; Cabergoline; Cost-utility; ICER; Prolactinoma;