手术及药物治疗垂体催乳素腺瘤的成本效果分析

Cost-effectiveness analysis of two therapeutic methods for prolactinoma

目的了解手术及药物治疗垂体催乳素腺瘤的效果，和达到相同效果时两种治疗方案的最小成本。方法回顾性分析经鼻经蝶垂体腺瘤切除手术（TSS）治疗和药物治疗的垂体催乳素腺瘤患者的资料，分析两种治疗方案的效果，并设计出两种垂体催乳素腺瘤治疗过程的马尔科夫概率决策模型。将得出的数据拟合入马尔科夫概率决策模型，得出达到相同治疗效果时两种方案的最小成本：结果微腺瘤患者中手术治疗者的血清催乳素水平正常化率为85％（22／26），药物治疗者为95％（19／20），两者比较，差异无统计学意义（P〉0．05）；大腺瘤患者中药物治疗者血清催乳素水平正常化率为5／5，手术治疗者为45％（19／42），两者比较，差异有统计学意义（P〈0．05）。根据马尔科夫概率决策模型测算，微腺瘤患者经手术治疗达到血清催乳素水平正常化的成本为人民币25129．25元，采用药物治疗的成本为人民币24943．99元，两者相当。大腺瘤患者采用药物治疗的费用为人民币25344．38元，经手术治疗的费用为人民币35208．20元。结论垂体催乳素微腺瘤患者经手术治疗，可达到与药物治疗相同的效果，且费用相当。大腺瘤患者手术治疗比药物治疗效果差，且费用较高。应用马尔科夫概率决策模型来预测垂体催乳素腺瘤患者一生的治疗费用是一种有效的方式。

Objective To evaluate the therapeutic responses to transsphenoidal surgery and medical therapy in terms of normalization of prolactin（ PRL）, mortality, morbidity and the cost-effectiveness of PRL normalization in order to establish an individualized therapeutic protocol for the patients with prolactinoma. Methods A retrospective study was undertaken of a consecutive series of patients with prolactinoma who were followed for at least 1 year after transsphenoidal surgery or medical treatment. The clinical characteristics and the long-term outcomes （normalization of PRL, morbidity or mortality） were assessed. Utilizing the principle of medical economics and data from the two types of treatment, we worked out a Markov chain and calculated the lowest cost of two kinds of therapeutic protocols. Results （ 1 ） The success rate of normalizing serum PRL through surgical treatment in microadenoma was 85% （22/26）, and that of medical treatment was 95% （19/20）. There was no statistical difference between the two therapies （ P 〉 0. 05 ）. The success rate of normalizing serum PRL through surgical treatment in macroadenoma was 45% （19/42）, and that of medical treatment was 5/5. There was a statistical difference between the two therapies （P 〈 0. 05 ）. （2） According to the Markov model, it would cost a microprolactinoma patient 25 129. 25 yuan to normalize serum PRL by surgical treatment. This is comparable to the cost of medical treatment which would be 24 943.99 yuan. Whereas for a macroprolactinoma patient surgery would cost 35 208.20 yuan and medical treatment would cost 25 344. 38 yuan. Conclusions Medical therapy is superior to surgical treatment in regard to complication rate and cost-effectiveness for macro- and extra big prolactinomas. Transsphenoidal surgery remains an option for patients with microadenomas. Markov model is an effective way to predict the treatment cost for patients with hyperprolactinoma at different ages and with different causes.