Abstract 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.
Kelz et al. (Fri,) studied this question.