What is the Cost of Selectivity? Selective and Nonselective Alpha Blockade Costs Associated with Adrenalectomy for Pheochromocytoma

BACKGROUND: Alpha-blockade is utilized in the preoperative preparation of patients with pheochromocytomas. Both selective and nonselective alpha-blockade are safe with equivalent clinical outcomes; the goal of this study was to evaluate the comparative costs of selective and nonselective alpha-blockade. PATIENTS AND METHODS: We performed a retrospective cohort study (2004-2022) of patients who underwent adrenalectomy for pheochromocytoma with preoperative alpha-blockade from Optum's deidentified Clinformatics® Data Mart Database. Patients were stratified by treatment with selective (prazosin, doxazosin, terazosin) or nonselective (phenoxybenzamine) alpha-blockade. Primary outcomes were: (1) costs of alpha-blockade in the 30 days prior to surgery (AB) and (2) adjusted standard costs from admission to discharge (AC). Secondary outcomes included length of hospital stay (LOS), intensive care unit (ICU) admission, costs 30 days after discharge (AD), and cumulative costs (CC). RESULTS: In total, 384 patients received selective, and 418 patients received nonselective alpha-blockade. The median age was 58 years (IQR 21 years). Median AB was significantly lower in the selective compared with nonselective alpha-blockade group ($19.73 versus $1033.70, p < 0.001). Median AC ($31,104.47 versus $31,471.90, p = 0.428) and AD ($790.78 versus $715.10, p = 0.074) were not significantly different between selective compared with nonselective alpha-blockade groups. On multivariable regression modeling, higher Elixhauser score (coeff.: $1,801.20, p < 0.001) and longer LOS (coeff.: $1842.33, p < 0.001) were associated with higher CC, while age (coeff.: $- 143.22, p = 0.044) was associated with lower CC. Notably, alpha-blockade strategy was not significantly associated with CC. CONCLUSIONS: When compared with nonselective alpha blockers, selective alpha blockers are associated with lower medication costs but equivalent hospitalization and post-hospitalization costs.