{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T01:37:07Z","timestamp":1773020227203,"version":"3.50.1"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>An 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).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Under 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%.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Using 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.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.2.jns221903","type":"journal-article","created":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:35:06Z","timestamp":1680309306000},"page":"1207-1215","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness of postoperative imaging surveillance strategies for nonfunctional pituitary adenomas after resection with curative intent"],"prefix":"10.3171","volume":"139","author":[{"given":"Lisa","family":"Caulley","sequence":"first","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery,"},{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;"},{"name":"Departments of Epidemiology,"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stijntje W.","family":"Dijk","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics,"},{"name":"Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, The Netherlands;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eline","family":"Krijkamp","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selina X.","family":"Dong","sequence":"additional","affiliation":[{"name":"Undergraduate Medicine, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahad","family":"Alkherayf","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liza","family":"Amrani","sequence":"additional","affiliation":[{"name":"Undergraduate Medicine, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary-Anne","family":"Doyle","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;"},{"name":"Medicine, Endocrinology and Metabolism, University of Ottawa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anas","family":"Eid","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Johnson-Obaseki","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery,"},{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Khoury","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Montr\u00e9al, Qu\u00e9bec, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janine","family":"Malcolm","sequence":"additional","affiliation":[{"name":"Medicine, Endocrinology and Metabolism, University of Ottawa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorsa","family":"Mavedatnia","sequence":"additional","affiliation":[{"name":"Undergraduate Medicine, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Sahlollbey","sequence":"additional","affiliation":[{"name":"Undergraduate Medicine, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Schramm","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery,"},{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Whelan","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology\u2013Head and Neck Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kednapa","family":"Thavorn","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;"},{"name":"School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; 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