Innovative Approaches to Improve the Success of Pituitary Surgery in Cushing's Disease: A Cost-Effectiveness Perspective

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2025-05-05 DOI:10.1111/cen.15263

Femke J. C. Jacobs, Tim M. Govers, Jurgen J. Fütterer, Annenienke van de Ven, Maroeska M. Rovers

{"title":"Innovative Approaches to Improve the Success of Pituitary Surgery in Cushing's Disease: A Cost-Effectiveness Perspective","authors":"Femke J. C. Jacobs, Tim M. Govers, Jurgen J. Fütterer, Annenienke van de Ven, Maroeska M. Rovers","doi":"10.1111/cen.15263","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Patients require additional treatment when pituitary surgery for Cushing's disease is unsuccessful. Exciting innovations in pituitary surgery bring hope for achieving better outcomes. Quantifying the potential value of these innovations using early health economic modelling can provide guidance throughout their development. The aim of this study was to explore the conditions for success of these innovations using cost-effectiveness analyses.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>The model consists of a decision tree and state-transition model with a 10-year time horizon.</p>\n </section>\n \n <section>\n \n <h3> Patients</h3>\n \n <p>The model simulates the clinical management of patients with Cushing's disease and pituitary surgery as primary treatment.</p>\n </section>\n \n <section>\n \n <h3> Measurements</h3>\n \n <p>Model input was derived from literature and expert opinion. Model outcomes were incremental healthcare costs and incremental quality-adjusted life-years (QALY). We performed scenario analyses, including a headroom and threshold analysis, to determine the maximum innovation price for cost-effectiveness. Probabilistic sensitivity analysis and one-way sensitivity analyses were performed to address the impact of uncertainty on outcome parameters.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The headroom analysis showed that per patient 0.028 QALYs could be gained and 2082 euros could be saved over 10 years. With a willingness to pay of 80,000 euros, the maximum price of an innovation is 4288 euros (95% CI: 3377–5181) to reach cost-effectiveness. Sensitivity analyses showed that utility values mainly determined cost-effectiveness.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our early health economic model exploring the conditions for success of innovations in pituitary surgery shows room for improvement, but also the importance of accurate health-related quality of life data to assess the economic value of innovations in individuals with CD.</p>\n </section>\n </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 2","pages":"216-224"},"PeriodicalIF":2.4000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15263","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cen.15263","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Patients require additional treatment when pituitary surgery for Cushing's disease is unsuccessful. Exciting innovations in pituitary surgery bring hope for achieving better outcomes. Quantifying the potential value of these innovations using early health economic modelling can provide guidance throughout their development. The aim of this study was to explore the conditions for success of these innovations using cost-effectiveness analyses.

Design

The model consists of a decision tree and state-transition model with a 10-year time horizon.

Patients

The model simulates the clinical management of patients with Cushing's disease and pituitary surgery as primary treatment.

Measurements

Model input was derived from literature and expert opinion. Model outcomes were incremental healthcare costs and incremental quality-adjusted life-years (QALY). We performed scenario analyses, including a headroom and threshold analysis, to determine the maximum innovation price for cost-effectiveness. Probabilistic sensitivity analysis and one-way sensitivity analyses were performed to address the impact of uncertainty on outcome parameters.

Results

The headroom analysis showed that per patient 0.028 QALYs could be gained and 2082 euros could be saved over 10 years. With a willingness to pay of 80,000 euros, the maximum price of an innovation is 4288 euros (95% CI: 3377–5181) to reach cost-effectiveness. Sensitivity analyses showed that utility values mainly determined cost-effectiveness.

Conclusion

Our early health economic model exploring the conditions for success of innovations in pituitary surgery shows room for improvement, but also the importance of accurate health-related quality of life data to assess the economic value of innovations in individuals with CD.

Abstract Image

查看原文本刊更多论文

提高库欣病垂体手术成功率的创新方法：成本效益视角

目的：当垂体手术治疗库欣病不成功时，患者需要额外的治疗。垂体手术令人兴奋的创新带来了取得更好结果的希望。利用早期卫生经济模型对这些创新的潜在价值进行量化，可以在其整个发展过程中提供指导。本研究的目的是利用成本效益分析来探索这些创新成功的条件。设计：该模型由决策树和具有10年时间范围的状态转换模型组成。患者：该模型模拟以垂体手术为主要治疗手段的库欣病患者的临床管理。测量方法：模型输入来源于文献和专家意见。模型结果为增加的医疗费用和增加的质量调整生命年（QALY）。我们进行了情景分析，包括净空和阈值分析，以确定成本效益的最大创新价格。进行概率敏感性分析和单向敏感性分析，以解决不确定性对结果参数的影响。结果：净空分析显示，10年内每位患者可获得0.028个QALYs，节省2082欧元。在愿意支付8万欧元的情况下，一项创新的最高价格为4288欧元（95% CI: 3377-5181），以达到成本效益。敏感性分析表明，效用值主要决定成本-效果。结论：我们的早期健康经济模型探索垂体手术创新成功的条件，显示出改进的空间，但也表明准确的健康相关生活质量数据对于评估CD患者创新的经济价值的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.