A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas


  • Michele Basile High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome https://orcid.org/0000-0002-1098-2648
  • Ilaria Valentini High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome https://orcid.org/0000-0001-5940-7495
  • Roberto Attanasio AME Scientific Committee, Milan https://orcid.org/0000-0002-1417-287X
  • Renato Cozzi ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan https://orcid.org/0000-0003-0421-5589
  • Agnese Persichetti Ministry of Interior, Department of Firefighters, Public Rescue and Civil Defense, Rome
  • Irene Samperi Endocrinology, ASL Novara, Piedmont
  • Alessandro Scoppola Endocrinology, Ospedale Santo Spirito, Rome https://orcid.org/0000-0002-6490-0978
  • Renata Simona Auriemma Department of Clinical Medicine and Surgery, Endocrinology Section, ‘Federico II’ University of Naples, Naples
  • Ernesto De Menis Internal Medicine 2, Treviso Hospital, Treviso and Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto https://orcid.org/0009-0009-6043-3725
  • Felice Esposito Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
  • Emanuele Ferrante Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan https://orcid.org/0000-0002-0556-7650
  • Giuseppe Iatì Department of Radiation Oncology, University of Messina, Messina
  • Diego Mazzatenta Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna https://orcid.org/0000-0002-2466-8828
  • Maurizio Poggi Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome
  • Roberta Rudà Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin
  • Fabio Tortora Radiology Unit, Department of Advanced Biomedical Sciences, University “Federico II”, Naples
  • Fabio Cruciani Department of Epidemiology, Lazio Region Health Service, Rome https://orcid.org/0000-0001-5533-8357
  • Zuzana Mitrova Department of Epidemiology, Lazio Region Health Service, Rome - Italy https://orcid.org/0000-0002-7644-7939
  • Rosella Saulle Department of Epidemiology, Lazio Region Health Service, Rome https://orcid.org/0000-0003-4358-0415
  • Simona Vecchi Department of Epidemiology, Lazio Region Health Service, Rome https://orcid.org/0000-0002-3893-8403
  • Paolo Cappabianca Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
  • Agostino Paoletta ULSS6 Euganea, Endocrinology, Padova
  • Alessandro Bozzao Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome https://orcid.org/0000-0002-8865-0723
  • Marco Caputo Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI)
  • Francesco Doglietto Institute of Neurosurgery, Catholic University School of Medicine, Rome https://orcid.org/0000-0002-7438-0734
  • Francesco Ferraù Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina https://orcid.org/0000-0002-7472-6598
  • Andrea Gerardo Lania Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI)
  • Stefano Laureti General Practitioner, USL Umbria 1, Perugia
  • Stefano Lello Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome https://orcid.org/0000-0002-1616-9105
  • Davide Locatelli Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese
  • Pietro Maffei Department of Medicine (DIMED), 3rd Medical Clinic, Padua University, Padua https://orcid.org/0000-0002-1717-263X
  • Giuseppe Minniti Department of Medicine, Surgery and Neurosciences, University of Siena, Siena https://orcid.org/0000-0003-1239-1603
  • Alessandro Peri Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence
  • Chiara Ruini Department of Psychology, University of Bologna, Bologna https://orcid.org/0000-0002-7805-3183
  • Fabio Settanni Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin
  • Antonio Silvani Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
  • Nadia Veronese ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
  • Franco Grimaldi AME past president, Udine https://orcid.org/0000-0002-7527-8010
  • Enrico Papini Endocrinology, Ospedale Regina Apostolorum, Albano Laziale (RM) - Italy
  • Americo Cicchetti High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome




Bromocriptine, Cabergoline, Cost-utility, ICER, Prolactinoma


Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma.

Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies.

Methods: The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure’s specific drivers that contributed to its total cost.

Results: The average cost of the first year of treatment was €2,558.91 and €3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were €798.13 and €1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of €3,201.15 compared to bromocriptine, based on a willingness-to-pay of €40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of €44,846.64. Considering a willingness-to-pay of €40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that.

Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.


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How to Cite

Basile, M., Valentini, I., Attanasio, R., Cozzi, R., Persichetti, A., Samperi, I., Scoppola, A., Auriemma, R. S., Menis, E. D., Esposito, F., Ferrante, E., Iatì, G., Mazzatenta, D., Maurizio Poggi, Rudà, R., Tortora, F., Cruciani, F., Mitrova, Z., Saulle, R., Vecchi, S., Cappabianca, P., Paoletta, A., Bozzao, A., Caputo, M., Doglietto, F., Ferraù, F., Lania, A. G., Laureti, S., Lello, S., Locatelli, D., Maffei, P., Minniti, G., Peri, A., Ruini, C., Settanni, F., Silvani, A., Veronese, N., Grimaldi, F., Papini, E., & Cicchetti, A. (2024). A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas. Global and Regional Health Technology Assessment, 11(1), 1–16. https://doi.org/10.33393/grhta.2024.2601



Original Research Articles


Received 2023-05-08
Accepted 2023-11-22
Published 2024-01-09


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