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Objective: Pituitary adenomas and their consequences impact mortality and morbidity. We studied the healthcare costs, survival, and cost-effectiveness of growth hormone (GH) vs no GH replacement in patients with non-functioning pituitary adenoma (NFPA)., Design and Methods: A cohort study including all NFPA patients followed from 1987 or the date of diagnosis until the time of death or December 31, 2019, in the Västra Götaland region, Sweden. Data to assess resource use, costs, survival, and cost-effectiveness were collected from patient records and regional/national healthcare registries., Results: A total of 426 patients with NFPA (274 men) with a follow-up of 13.6 ± 6.8 years (mean ± SD) were included. The total annual healthcare cost was higher in patients receiving GH (€9287) than those without GH (€6770), mainly driven by a higher pharmaceutical cost. Glucocorticoid replacement therapy (P = .02), diabetes insipidus (P = .04), body mass index (BMI) (P < .01), and hypertension (P < .01) were all individually associated with a higher total annual cost. The survival rate was higher in the GH group (HR [hazard ratio] 0.60; P = .01) and reduced in patients with glucocorticoid replacement (HR 2.02; P < .01) or diabetes insipidus (HR 1.67; P = .04). The cost per gained life-year for GH vs no GH replacement was about €37 000., Conclusions: This healthcare utilization study identified several factors driving the cost of care in NFPA patients, such as GH replacement, adrenal insufficiency, and diabetes insipidus. Life expectancy was increased in those with GH replacement and reduced in patients with adrenal insufficiency and diabetes insipidus., Competing Interests: Conflicts of interest: D.S.O. has been a consultant for Sandoz, Ipsen, and Pfizer; has received unrestricted grants from Sandoz and Pfizer; and is an employee at AstraZeneca as of August 8, 2021. A.D.G. was an employee of Pfizer AB and owned Pfizer stock at the time of this work and is at the time of manuscript submission an employee of AbbVie AB. G.J. has served as a consultant for Astra Zeneca, Novo Nordisk, and Takeda/Shire and has received lecture fees from Novo Nordisk, Pfizer, and Takeda/Shire. M.S. and F.L. have nothing to declare., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Endocrinology.)