Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults

Caulley, Lisa; Quinn, Jason G.; Doyle, Mary‐Anne; Alkherayf, Fahad; Kilty, Shaun; Hunink, M. G. Myriam

doi:10.1002/14651858.cd013561

Cited by 2 publications

(2 citation statements)

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“…Health state transition probabilities of moving between health states were based on a systematic review of surgical and non-surgical therapy for GH-secreting adenomas that has been published elsewhere [ 39 ]. Transition probabilities were presented per cycle length (that is, 3 month probabilities).…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of direct surgery versus preoperative octreotide therapy for growth-hormone secreting pituitary adenomas

et al. 2022

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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.

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Section: Methodsmentioning

confidence: 99%

“…Hazard rates were modeled from published RCTs to incorporate time-dependent risk of treatment failure after surgery alone, and preoperative medical and surgical therapy (eFig. 1) [ 39 ]. Observational studies suggest that rates of long-term remission for primary surgery are similar to those of revision surgery [ 40 , 41 ].…”

Section: Methodsmentioning

confidence: 99%