• Lisa Caulley, Stijntje W Dijk, Eline Krijkamp, Selina X Dong, Fahad Alkherayf, Liza Amrani, Mary-Anne Doyle, Anas Eid, Stephanie Johnson-Obaseki, Michel Khoury, Janine Malcolm, Dorsa Mavedatnia, Nick Sahlollbey, David Schramm, Jonathan Whelan, Kednapa Thavorn, Shaun Kilty, and HuninkMyriam G MMGM5Epidemiology and Biostatistics.13Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts..
• Departments of1Otolaryngology-Head and Neck Surgery.
• J. Neurosurg. 2023 Nov 1; 139 (5): 120712151207-1215.

ObjectiveThe aim of this study was to determine an optimal follow-up imaging surveillance strategy in terms of cost-effectiveness after resection of nonfunctioning pituitary adenomas with curative intent.MethodsAn individual-level state-transition microsimulation model was used to simulate costs and outcomes associated with three postoperative imaging strategies over a lifetime time horizon: 1) annual MRI surveillance, 2) tapered MRI surveillance (annual surveillance for 5 years followed by surveillance every 2 years), and 3) personalized surveillance (annual surveillance for 5 years followed by surveillance every 2 years when MRI shows remnant disease/postoperative changes, and surveillance at 7, 10, and 15 years for disease-free MRI). Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually. Model outcomes included lifetime costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).ResultsUnder base case assumptions, annual surveillance yielded higher costs and lower health effects (QALYs) compared with the tapered and personalized surveillance strategies (dominated). Personalized surveillance demonstrated an additional 0.1 QALY at additional cost ($1298) compared with tapered surveillance (7.7 QALYs at a cost of $12,862). The ICER was $11,793/QALY. The optimal decision was most sensitive to the probability of postoperative changes on MRI after surgery and MRI cost. Accounting for parameter uncertainty, personalized surveillance had a higher probability of being a cost-effective surveillance option compared with the alternative strategies at 79%.ConclusionsUsing standard cost-effectiveness thresholds in the US ($100,000/QALY), personalized surveillance that accounted for remnant disease or postoperative changes on MRI was cost-effective compared with alternative surveillance strategies.

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