MANAGEMENT OF INCIDENTAL PITUITARY MICROADENOMAS - A COST-EFFECTIVENESS ANALYSIS

The objective of this study was to compare the cost-effectiveness of f our management strategies for a patient with an incidentally discovere d asymptomatic pituitary microadenoma. A decision analytic Markov mode l was used to determine the incremental cost-effectiveness of four cli nical management strategies: 1) expectant management, 2) PRL screening , 3) an endocrine screening panel (PRL, insulin-like growth factor I, and 1-mg dexamethasone suppression test), and 4) magnetic resonance im aging (MRI) follow-up. The model incorporated the natural history of i ncidental microadenomas, test characteristics, pharmacological and sur gical treatment outcomes, patient's quality of life, discounting, and the costs of hormone testing, bromocriptine, MRIs, hospitalization for surgery, and physician services.PRL screening, endocrine screening pa nel, and MRI follow-up all provided slightly greater quality-adjusted survival than expectant management, but the costs increased disproport ionately more than the benefits. The incremental cost per quality-adju sted life year for PRL screening is $1,428, and that for the endocrine screening panel is $69,495. These results are most sensitive to patie nt anxiety about the microadenoma; increased anxiety shifts the recomm ended strategy to the endocrine screening panel. We conclude that in p atients with an incidental asymptomatic pituitary microadenoma, a sing le PRL test may be the most cost-effective management strategy.