Evidence map›Paper›PMID 36030360›Full record

ArticlePituitary2022

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

Lisa Caulley, Eline Krijkamp, Mary-Anne Doyle, Kednapa Thavorn, Fahad Alkherayf, Nick Sahlollbey, Selina X Dong, Jason Quinn, Stephanie Johnson-Obaseki, David Schramm and 2 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pituitary, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 3 countries.

Lisa CaulleyDepartment of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada. Lic955@mail.harvard.edu.
Eline KrijkampDepartment of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Mary-Anne DoyleDepartment of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada.
Kednapa ThavornClinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
Fahad AlkherayfThe Ottawa Hospital Research Institute, Ottawa, Canada.
Nick SahlollbeyDepartment of Undergraduate Medicine, University of Ottawa, Ottawa, Canada.
Selina X DongDepartment of Undergraduate Medicine, University of Ottawa, Ottawa, Canada.
Jason QuinnDepartment of Pathology, Dalhousie University, Halifax, Canada.
Stephanie Johnson-ObasekiDepartment of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
David SchrammDepartment of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Shaun J Kilty *Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Myriam G M Hunink *Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Ottawa Hospital Research InstituteUniversity of Ottawa · CAErasmus MC · NLDalhousie University · CAOttawa Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe 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.

methodsWe 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).

resultsUnder 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.

conclusionsUsing 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.

Indexed as

AdenomaGrowth Hormone-Secreting Pituitary AdenomaPituitary NeoplasmsCost-Benefit AnalysisHormonesHumansOctreotideHormonesOctreotideCost-effectivenessDecision modelGrowth-hormonePituitary adenomas

Identifiers

PMID36030360
PMCPMC9675692
OpenAlexW4293879884

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.