Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

Abstract

Purpose Prolactinomas are the most prevalent functioning pituitary adenomas. They affect gonadal function as well as health-related quality of life (HRQoL). This study aimed to report healthcare utilization and costs, including their determinants, for prolactinoma patients. Methods Cross-sectional study of 116 adult prolactinoma patients in chronic care in a Dutch tertiary referral center. Patients completed four validated questionnaires, assessing healthcare utilization and costs over the previous 12 months (Medical Consumption Questionnaire), disease bother and needs (Leiden Bother and Needs Questionnaire Pituitary), HRQoL (Short Form-36), and self-reported health status (EuroQol 5D). Regression analyses were used to assess associations between disease-related characteristics and healthcare utilization and costs. Results Mean age was 52.0 years (SD 13.7) and median follow-up was 15.0 years (IQR 7.6–26.1). Patients visited the endocrinologist (86.2%), general practitioner (37.9%), and ophthalmologist (25.0%) most frequently. Psychological care was used by 12.9% of patients and 5% were admitted to hospital. Mean annual healthcare costs were €1928 (SD 3319), mainly for pituitary-specific medication (37.6% of total costs), hospitalization (19.4%) and specialist care (16.1%). Determinants for higher healthcare utilization and costs were greater disease bother and needs for support, lower HRQoL, elevated prolactin, and longer disease duration, while tumor size, hypopituitarism and adrenal insufficiency were not significantly associated with healthcare utilization and costs. Conclusion Healthcare utilization and costs of prolactinoma patients are related to patient-reported HRQoL, bother by disease and needs for support. Therefore, addressing patients’ HRQoL and needs is a way forward to improve efficiency of care and patients’ health status.

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

“…[61] Interestingly, tumor size and prolactinoma treatment were however not significantly associated with healthcare utilization [61]. In addition, treatment costs were not significantly higher for patients with a macroprolactinoma, except in terms of medication costs [61].…”

“…Recently, it has been demonstrated that healthcare utilization and costs of patients treated for a prolactinoma are mainly associated with health-related quality of life. [ 61 ] Interestingly, tumor size and prolactinoma treatment were however not significantly associated with healthcare utilization [ 61 ]. In addition, treatment costs were not significantly higher for patients with a macroprolactinoma, except in terms of medication costs [ 61 ].…”

“…[ 61 ] Interestingly, tumor size and prolactinoma treatment were however not significantly associated with healthcare utilization [ 61 ]. In addition, treatment costs were not significantly higher for patients with a macroprolactinoma, except in terms of medication costs [ 61 ]. With regard to the treatment strategy being chosen, transsphenoidal surgical resection of microprolactinomas has been shown to be more cost-effective than life-long medical therapy in young patients with a life expectancy greater than 10 years [ 62 ].…”

Costs and Its Determinants in Pituitary Tumour Surgery

“…However, the USA has a different healthcare system than most European countries (52). European economic evaluations, reported lower annual direct costs of €8000-12000 (17,29,53) for patients with acromegaly (17,18,29,54), €2000 for prolactinoma (20) and €3000 (19) for NFA. However, these studies included yearly chronic care instead of the year of surgical intervention associated with a peak in costs (18)(19)(20)(21)26).…”

“…Previous cost evaluation studies in pituitary healthcare were limited to the surgical procedure (12), index hospitalization (12)(13)(14), complications or readmissions (15,16), instead of encompassing the entire perioperative trajectory. Other studies focussed on a single diagnosis, limiting comparisons between pituitary tumour types and other case mix variables and prohibiting evaluation of the care pathways and the required capacity within the pituitary healthcare team (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Moreover, many studies assessed predictors of healthcare costs instead of cost determinants (24,28) with predictors not being cost drivers per se.…”