Clinical Characteristic And Cost-effectiveness Analysis Of Two Therapeutic Regimen Of Prolactinoma

Clinical characteristic and cost—effectiveness analysis of two therapeutic methods of prolactinomaBACKGROUNDProlactin-secreting tumors are the most common and account for about 40 to 60 percent of all the hormonr-secreting pituirary tumors. Rarely life-threatening, they cause symptoms primarily as a result of hyperprolactinemia. Except for a few particular conditions, the evaluation of hyperprolactinemia is easy since the routine use of magnetic resonance imaging (MRI) scan allow us to identify microadenomas. Options for treatment include observation with careful follow-up, surgery, radiotherapy and medicine. Medical therapy is generally considered to be the primary choice. While in the last 10 years, with the development of surgical technique, it was considered that surgery is also an acceptable therapy in the cost-effective point of view. In fact, there are no formal guidelines for the management of prolactinoma. OBJECTAccording to most literatures, the success rates for transsphenoidal surgery are highly depend upon the experience and skill of the surgeon, as well as the size of the tumor. Our purpose is to evaluate the therapeutic responses to transsph surgery and medical therapy, such as normalization of PRL, mortality, morbidity and the cost-effective issue for PRL normalization to make a individualize therapeutics protocol for the patients.METHOD1. A retrospective study was undertaken to review a consecutive series of patients who were followed for at least 1 year after transsphenoidal surgery to clarify the clinical characteristic, to assess the long-term hormonal outcome (normalization of PRL, morbidity or mortality).2. A retrospective study was undertaken to review a consecutive series of patients who were followed for at least 1 year after medical treatment to assess the long-term hormonal outcome (normalization of PRL and side effects).3. Utilizing the principle of medical economics and the data that yield out from the above two parts of the study, we made out a Markov chain and calculated the smallest cost of two kinds of therapeutic proprotocols.RESULT1. Medical treatment is better than surgical therapy in normalizaling serum PRL in macroadenoma and extra big adenoma. For microprolactinoma two regimens are both effective.2. Complications after transsphenoidal surgery for prolactinomas are quite frequent.3. In order to normalize the serum PRL, patients usually will pay more money using surgical treatment than medical regimen except for MIC.CONCLUSION1. Medical therapy is superior to surgical treatment in the complication and cost-effectiveness point of view for macro-and extra big prolactinomas. Transsphenoidal surgery remains an option for patients with microadenomas.2. Markov model is an effective way to predict the treatment cost for hyperprolactinemia in different age with different cause.3. Because of not doing the cost-utility analysis, it could not yet be concluded that which is the optimizing regimen.