Cost-effectiveness of the endoscopic versus microscopic approach for pituitary adenoma resection

• Published in: The Laryngoscope 2015-01, Vol.125 (1), p.16-24
• Main Authors: Rudmik, Luke, Starreveld, Yves P., Vandergrift, William A., Banglawala, Sarfaraz M., Soler, Zachary M.
• Format: Article
• Language: English
• Subjects: Adenoma - surgery; cost utility analysis; Cost-Benefit Analysis; cost-effectiveness analysis; Decision Trees; economic evaluation; endoscopic; Endoscopy; Endoscopy - economics; Female; Humans; hypophysectomy; Hypophysectomy - economics; Markov Chains; microscopic; Microsurgery - economics; Middle Aged; Models, Economic; Pituitary adenoma; Pituitary gland; Pituitary Neoplasms - surgery; Postoperative Complications - economics; Postoperative Complications - etiology; Quality-Adjusted Life Years; Sensitivity analysis; Tumors
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.24780

Objectives/Hypothesis To evaluate the cost‐effectiveness of an endoscopic versus microscopic approach to pituitary adenoma resection. Study Design Markov decision tree economic evaluation. Methods An economic evaluation using a Markov decision tree model was performed. The economic perspective was that of the healthcare third‐party payer. Effectiveness and probability data were obtained from a single meta‐analysis of 38 studies. Costs were obtained from the Healthcare Cost and Utilization Project database and wholesale pharmaceutical pricing. Multiple sensitivity analyses were performed including a probabilistic sensitivity analysis. Comparative treatment groups were: 1) endoscopic approach and 2) microscopic approach to pituitary adenoma resection. The primary outcome was cost per quality‐adjusted life year (QALY). The time horizon was 25 years, and costs were discounted at a rate of 3.5%. Results The endoscopic approach cost a total of $17,244.63 and produced a total of 24.30 QALYs. The microscopic approach cost a total of $23,756.60 and produced a total of 24.20 QALYs. In the reference case, the endoscopic approach was a dominant intervention (both less costly and more effective); therefore, an incremental cost‐effectiveness ratio was not calculated. The sensitivity analysis demonstrated 79% certainty that the endoscopic approach is the cost‐effective decision, at a willingness to pay threshold of $50,000 per QALY. Conclusions This economic evaluation suggests that the endoscopic approach is the more cost‐effective intervention compared to the microscopic approach for patients requiring a pituitary adenoma resection. Level of Evidence NA Laryngoscope, 125:16–24, 2015