Cushing's Syndrome Treatment Cost

Typical costs:

• For patients covered by health insurance, out-of-pocket costs for Cushing's syndrome treatment typically consist of doctor visit copays, prescription drug copays and, for surgery, coinsurance of 10-50% or more. Cushing's syndrome treatment typically would be covered by health insurance, though certain treatments might be considered experimental. For example, Aetna[1] considers the drug mifepristone investigational for the treatment of Cushing's syndrome.
• For patients not covered by health insurance, the cost of treatment for Cushing's syndrome varies by treatment, and can range from less than $1,000 for adjustment of medications under a doctor's supervision, if the Cushing's syndrome is caused by medications the patient is taking for another condition. Otherwise, it can cost up to $200-$600 per month for medication -- or up to $2,400-$7,000 per year. For example, Drugstore.com charges about $200 for a one-month supply of generic ketoconazole, a drug sometimes used off-label to treat Cushing's syndrome, and charges about $400 for a one-month supply of the brand-name version, Nizoral. Drugstore.com charges as much as almost $1,500 or more for a one-month supply of an initial dose, or up to almost $600 for a one-month supply of a maintenance dose -- about $7,000 a year -- for the brand-name drug Lysodren, which is not available in a generic version.
• Treatment for Cushing's syndrome with radiation or surgery can cost $12,000-$55,000 or more. For example, stereotactic radiosurgery typically costs $12,000-$55,000. Uninsured patients on a forum at Cushing's Help report total costs of $20,000-$40,000 for pituitary tumor removal with cash-pay discounts, while patients with insurance report up to $75,000 or more billed to their insurance companies. Pituitary surgery typically is done through the nose, but if a craniotomy -- opening the skull -- is required, costs could reach $50,000-$150,000 or more.

• If the Cushing's syndrome is caused by use of corticosteroid drugs to manage another condition, such as asthma or arthritis, the doctor typically will attempt to lower the dose of the medication and/or substitute a different medication to treat the original condition. If the Cushing's syndrome is caused by a tumor in the pituitary gland, adrenal glands or elsewhere, a surgeon typically will perform a complete removal of the tumor if possible. Pituitary surgery[2] typically is done transsphenoidally, in which the surgeon approaches through the nose and the sinus cavity behind it, instead of opening the skull. These surgeries typically require general anesthesia and a hospital stay of a few days. Afterward, the doctor typically will prescribe cortisol replacement medication until normal production of cortisol resumes.
• If a tumor cannot be completely removed, or if the patient cannot have surgery, radiation might be used. A doctor might recommend stereotactic radiosurgery, or multiple lower-dose radiation treatments over about six weeks. It typically takes up to two years or more after treatment to see results.
• In cases where surgery and radiation do not work, medications such as ketoconazole, mitotane or metyrapone might be used to control cortisone production.
• The Mayo Clinic offers an overview of Cushing's syndrome treatment[3] .

• In some cases, a doctor will prescribe medications to reduce cortisol before surgery. These can cost up to $100 or more per month.
• In some cases, Cushing's syndrome treatment can cause a hormone deficiency that requires treatment with a hormone replacement drug, such as hydrocortisone. This could cost as much as $80 or more per month.

• Some clinics offer specialist care. The U.S. Department of Health and Human Services offers a locator[4] for clinics that provide discounts on an income-based sliding scale.
• Many doctors and hospitals give discounts of up to 30% or more to uninsured/cash-paying patients. For example, Washington Hospital Healthcare System[5] in California offers a 35% discount.

• The American Association of Clinical Endocrinologists offers a doctor locator[6] .
• The American Board of Neurological Surgery offers a doctor locator[7] . It is very important to find a neurosurgeon with extensive experience removing pituitary tumors.
• Or, if the Cushing's syndrome is caused by an adrenal tumor that requires surgical removal, the endocrinologist can make a referral to a surgeon who specializes in endocrine surgery. The American Association of Endocrine Surgeons offers a doctor locator[8] .

1.  www.aetna.com/cpb/medical/data/400_499/0465.html
2.  pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm
3.  www.mayoclinic.com/health/cushings-syndrome/DS00470/DSECTION=treatments-and-drugs
4.  findahealthcenter.hrsa.gov/Search_HCC.aspx
5.  www.whhs.com/about/washington-hospital-discount-policy-for-uninsured/
6.  /www.aace.com/resources/find-an-endocrinologist
7.  www.abns.org/diplomates/default.aspx
8.  endocrinesurgery.org/membership/search/rosmemresultsz.phtml

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