Cushing’s disease (CD) is a costly disease, both in terms of its cost to the patient-physical, emotional, and financial-and its cost to society. The costs to the patient are represented by the increased mortality risk, about three-five fold in untreated disease, and the physical costs associated with its significant comorbidities – hypertension, diabetes, cardiac disease, obesity, osteoporosis, etc. Although many of these comorbidities improve with successful treatment, there may be substantial ongoing physical and emotional difficulties, even after resolution of the underlying hypercortisolemia. However, there has been little analysis of the financial burden associated with the disease.

We investigated the economic cost to the healthcare system associated with Cushing’s disease by analyzing insurance claims from patients with Cushing’s disease as compared to patients with nonfunctioning pituitary tumors and patients without pituitary disease. The groups were identified by ICD-9 codes (national diagnosis codes used in classifying disease for administrative purposes) as submitted by physicians and hospitals to insurers in the course of treatment. As expected, the majority of Cushing’s patients were female (79%) with an average age of 43 years. When stratified by comorbidities, hypertension, diabetes, psychiatric disease including anxiety and depression, infections, and hospital admission for cardiovascular disease were 2-3 fold more common in Cushing’s patients than in non-Cushing’s pituitary patients or the general population. For every year analyzed, patients with Cushing’s disease had a significantly increased risk of hospital admission, outpatient physician visits, and medication use than in non-Cushing’s pituitary patients or non-pituitary controls. In 2008, overall health care costs per patient per year were $26,440 among patients with CD, compared with $13,708 among patients with non-functioning pituitary tumors and $5,954 among patients in the non-pituitary group. Inpatient, outpatient, and pharmacy costs were all significantly higher in Cushing’s patients.

We also analyzed costs after successful versus unsuccessful surgical treatment. A sub-group of CD patients who underwent transsphenoidal surgery was identified. Since the database does not contain specific remission criteria, we defined remission as the absence of secondary treatment after surgery (meaning there were no claims/charges for radiation treatment, adrenalectomy, medications like ketoconazole commonly used to treat hypercortisolemia, or additional transsphenoidal surgery). Defined in this way, total costs almost doubled in the patient group not in remission. In addition, the costs of managing co-morbidities, especially hypertension and hyperlipidemia, also decreased significantly with remission.

Obviously, the most important rationale for aggressive treatment of CD lies with improved patient outcome, decreased co-morbidities, improved quality of life, and improved mortality risk with successful treatment. Nonetheless, our study shows that a successful pituitary surgery is additionally associated with cost benefits to the healthcare system as a whole, as well as to the individual patient.

Author: Dr. Brooke Swearingen, MD (Spring, 2012)

Editor’s Note: Dr. Swearingen is Associate Professor of Neurosurgery at Harvard Medical School and an Attending Neurosurgeon, at Massachusetts General Hospital. He is also Co-Director of the Neurological Intensive Care Unit. Dr. Swearingen is a world renowned pituitary surgeon and has conducted a wide range of research on Cushing’s Disease.

Selected references:

Swearingen B, Wu N, Chen SY, Pulgar S, Biller BM. Health care resource use and costs among patients with Cushing disease. Endocr Pract. 2011 Sep 1;17(5):681-90.