The Effect of Identifying Macroprolactinemia on Health-Care Utilization and Costs in Patients with Elevated Serum Prolactin Levels

ABSTRACTObjectivesThe routine screening for macroprolactin of all hyperprolactinemic patients may avoid unnecessary imaging procedures and medication prescription. The study described the frequency and types of tests requested after a diagnosis of high serum prolactin concentration, and assessed whether the diagnosis of macroprolactinemia resulted in lower downstream utilization and costs compared with hyperprolactinemic patients.MethodsA cost analysis was conducted using a decision tree to model the health-care utilization of the two groups. The database of the Fleury Medicina e Saúde provided the tests and medication of patients with a prolactin value ≥30 µg/L for a period of 6 months.ResultsSix hundred fifty-four of 1793 patients (36.5%) had hyperprolactinemia because of macroprolactin. The average number of tests per individual was higher (P = 0.001) in the patients with true hyperprolactinemia (3.07) than in patients with macroprolactinemia (2.51). The average cost in the hyperprolactinemic group (R$425 or €162) was significantly higher (P < 0.001) than the macroprolactinemic group (R$340 or €130), an incremental cost 25% higher.ConclusionThe macroprolactin screening did not completely avoid inappropriate clinical investigation or associated health-care costs. Our results demonstrate the importance of proper medical education and knowledge diffusion of the meaning of macroprolactinemia.