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. 2024 Jan 9:11:1-16.
doi: 10.33393/grhta.2024.2601. eCollection 2024 Jan-Dec.

A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas

Michele Basile  1 , Ilaria Valentini  1 , Roberto Attanasio  2 , Renato Cozzi  3 , Agnese Persichetti  4 , Irene Samperi  5 , Alessandro Scoppola  6 , Renata Simona Auriemma  7 , Ernesto De Menis  8 , Felice Esposito  9 , Emanuele Ferrante  10 , Giuseppe Iatì  11 , Diego Mazzatenta  12 , Maurizio Poggi  13 , Roberta Rudà  14 , Fabio Tortora  15 , Fabio Cruciani  16 , Zuzana Mitrova  16 , Rosella Saulle  16 , Simona Vecchi  16 , Paolo Cappabianca  9 , Agostino Paoletta  17 , Alessandro Bozzao  18 , Marco Caputo  19 , Francesco Doglietto  20 , Francesco Ferraù  21 , Andrea Gerardo Lania  22 , Stefano Laureti  23 , Stefano Lello  24 , Davide Locatelli  25 , Pietro Maffei  26 , Giuseppe Minniti  27 , Alessandro Peri  28 , Chiara Ruini  29 , Fabio Settanni  30 , Antonio Silvani  31 , Nadia Veronese  3 , Franco Grimaldi  32 , Enrico Papini  33 , Americo Cicchetti  1
Affiliations

A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas

Michele Basile et al. Glob Reg Health Technol Assess. .

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.

Keywords: Bromocriptine; Cabergoline; Cost-utility; ICER; Prolactinoma.

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Figures

Fig. 1 -
Fig. 1 -
Graphical representation of the probabilistic tree based on the possible outcomes of the treatments under consideration for the management of microprolactinoma patients.
Fig. 2 -
Fig. 2 -
One-way sensitivity analysis: A) Cabergoline vs bromocriptine; B) endoscopic surgery vs cabergoline. ICER = incremental cost-effectiveness ratio; MRI = magnetic resonance imaging.
Fig. 3 -
Fig. 3 -
Results of probabilistic sensitivity analysis: comparing cabergoline vs bromocriptine and endoscopic surgery vs cabergoline. QALY = quality-adjusted life year; WTP = willingness-to-pay.
Fig. 4 -
Fig. 4 -
Cost-effectiveness acceptability curve of cabergoline vs bromocriptine and endoscopic surgery vs cabergoline. INB = incremental net mone­tary benefit.
Fig. 5 -
Fig. 5 -
CEAF and EVPI of cabergoline vs bromocriptine and endoscopic surgery vs cabergoline. EVPI = expected value of perfect information; INB = incremental net mone­tary benefit.
See this image and copyright information in PMC

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