Prolactin Pituitary Adenoma Study Of Health Economics

Prolactinomors are almost always benign and usually are very slow growing. The clinical consequences of prolactinomas are mainly related to development of secondary hypogonadism and tumor mass effects. The treatment goal for microprolactinoma is to normalize the serum PRL levels and restore gonadal function and fertility, and for macroprolactinoma to reduce the tumour size is also important.Trans-sphenoidal surgery and dopamine agonists are two main therapeutic methods for prolactinoma. Which one of the two methods should be considerded as the initial management had not come to an agreement in china. The QOL in patients with prolactinoma had not been reported before in china.In this study, a retrospective analysis was made on the patients with prolactinoma in the Peking Union Medical College Hospital clinic, and the correlative literature on this subject was evaluated. Based on the data acquired from the clinical study and literature review, a markov model was constructed to simulate the clinical process of prolactinoma treated by TSS and bromocriptine, by which the costs of these two therapeutic alternatives were calculated and compared, and a sensitivity analysis was performed. A cross-section QOL evaluation was performed on the patients with prolactinoma, using SF-36questionnaire by the time of their clinical evaluation.We found that, the cost of treating with bromocriptine was similar in micro-, and cheaper in macroprolactinoma, compared with TSS, among the patients who could be treated with bromocriptine. Within the female patients of microprolactinoma, the ones with high PRL levels had lower scores in physical functioning than those with normal PRL levels, and the ones with amenorrhea had lower scores in general health than those with regular menses. The scores of physical functioning were inversely associated with the PRL levels.Therefore, we concluded that bromocriptine should be regarded as the first treatment for prolactinoma. Treating with bromocriptine is more cost effective for macroprolactinoma. An adequate disease control for these patients should be provided in order to avoid the adverse consequences of hyperprolactinemia and hypogonadism on QOL.