Sex-related differences in healthcare utilization and costs among patients with pituitary adenomas

To systematically summarize and evaluate the current evidence regarding sex-based differences in healthcare utilization (HCRU), direct costs, and indirect socioeconomic burden in patients with pituitary adenomas.

A systematic literature search of PubMed, EMBASE, and Web of Science identified studies reporting HCRU and/or cost data with sex-stratified analyses. Studies focusing on drug-specific cost-effectiveness, case reports, and scenario-based models were excluded. Eight studies met the inclusion criteria, including non-functioning pituitary adenoma, prolactinoma, acromegaly, Cushing's disease (CD), and perioperative pituitary tumor cohorts from Europe and the United States. Findings were synthesized narratively due to methodological heterogeneity and the scarcity of sex-specific cost estimates.

Total and surgical costs did not differ between men and women across most settings in Europe. Only one U.S. acromegaly cohort showed lower adjusted annual costs in women, and one Chinese perioperative patient cohort reported lower inpatient charges among women. In contrast, sex-based differences in HCRU were consistent and clinically relevant: women with acromegaly demonstrated longer diagnostic delays, more pre-diagnostic visits, higher specialist engagement, and more treatment modifications. Perioperatively, sex was not a predictor of length of stay or cost, but several cohorts reported higher rates of cerebrospinal fluid leak, arginine-vasopressin deficiency, and late hyponatremia in women. The most pronounced disparity was observed in indirect socioeconomic burden, with women more frequently experiencing reduced work capacity, early retirement, psychosocial distress, and poorer quality-of-life in acromegaly and CD.

Although sex-based differences in overall healthcare costs are limited, women face a disproportionately complex and burdensome care trajectory. Standardized, value-based care pathways may help mitigate these disparities, underscoring the need for prospective, sex-stratified studies.