Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery
Objective: Vestibular schwannomas are benign slowly growing tumors, with 3 treatment options: wait and scan, radiosurgery, and microsurgery with specific advantages and disadvantages. Contemporary debate has focused on medium size tumor. The present study used a Markov model to try to identify the c...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751921001481 |
| _version_ | 1823931834570899456 |
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| author | Yuhei Yoshimoto Takaaki Miyagishima Masanori Aihara Yukitaka Tanaka Tohru Shibazaki |
| author_facet | Yuhei Yoshimoto Takaaki Miyagishima Masanori Aihara Yukitaka Tanaka Tohru Shibazaki |
| author_sort | Yuhei Yoshimoto |
| collection | DOAJ |
| description | Objective: Vestibular schwannomas are benign slowly growing tumors, with 3 treatment options: wait and scan, radiosurgery, and microsurgery with specific advantages and disadvantages. Contemporary debate has focused on medium size tumor. The present study used a Markov model to try to identify the cost-effectiveness in a lifelong perspective of the “wait & scan” or “radiosurgery” strategies for Koos 2 and 3 tumors. Methods: The present model was defined by 5 discrete health states. All decision and chance nodes were assigned a probability of occurrence derived from a thorough review of the related literature. We calculated the expected effects and costs associated with the two strategies, then evaluated the incremental cost-effectiveness ratio. Sensitivity analysis was performed by altering the input values within a clinically reasonable range to assess the effects of uncertainties. Results: Radiosurgery always requires more costs than wait & scan, and seems to generate small effects. However, the incremental cost-effectiveness ratio was significantly influenced by the hazard ratio of risk generated by deferred radiosurgery. One-way and two-way sensitivity analysis indicated that radiosurgery always yields negative effectiveness, compared with wait & scan at hazard ratio of less than 3.0, regardless of any other assumptions. Conclusions: Treatment strategy for medium size vestibular schwannoma should primarily be based on the future increased risk of radiosurgery after failure of conservative management. Wait & scan strategy may be the optimum approach for most Koos 2 and 3 tumors, but relatively large Koos 3 tumors are candidates for immediate radiosurgery. |
| first_indexed | 2024-12-16T21:43:59Z |
| format | Article |
| id | doaj.art-d1bff3a1fec347f4bd6ddf0128b04839 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-16T21:43:59Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-d1bff3a1fec347f4bd6ddf0128b048392022-12-21T22:15:11ZengElsevierInterdisciplinary Neurosurgery2214-75192021-09-0125101236Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgeryYuhei Yoshimoto0Takaaki Miyagishima1Masanori Aihara2Yukitaka Tanaka3Tohru Shibazaki4Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; Corresponding authors at: Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, JapanDepartment of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, JapanDepartment of Neurosurgery, Hidaka Hospital, Takasaki, Gunma, JapanDepartment of Neurosurgery, Hidaka Hospital, Takasaki, Gunma, JapanObjective: Vestibular schwannomas are benign slowly growing tumors, with 3 treatment options: wait and scan, radiosurgery, and microsurgery with specific advantages and disadvantages. Contemporary debate has focused on medium size tumor. The present study used a Markov model to try to identify the cost-effectiveness in a lifelong perspective of the “wait & scan” or “radiosurgery” strategies for Koos 2 and 3 tumors. Methods: The present model was defined by 5 discrete health states. All decision and chance nodes were assigned a probability of occurrence derived from a thorough review of the related literature. We calculated the expected effects and costs associated with the two strategies, then evaluated the incremental cost-effectiveness ratio. Sensitivity analysis was performed by altering the input values within a clinically reasonable range to assess the effects of uncertainties. Results: Radiosurgery always requires more costs than wait & scan, and seems to generate small effects. However, the incremental cost-effectiveness ratio was significantly influenced by the hazard ratio of risk generated by deferred radiosurgery. One-way and two-way sensitivity analysis indicated that radiosurgery always yields negative effectiveness, compared with wait & scan at hazard ratio of less than 3.0, regardless of any other assumptions. Conclusions: Treatment strategy for medium size vestibular schwannoma should primarily be based on the future increased risk of radiosurgery after failure of conservative management. Wait & scan strategy may be the optimum approach for most Koos 2 and 3 tumors, but relatively large Koos 3 tumors are candidates for immediate radiosurgery.http://www.sciencedirect.com/science/article/pii/S2214751921001481Vestibular schwannomaCost effectivenessWait and scanRadiosurgery |
| spellingShingle | Yuhei Yoshimoto Takaaki Miyagishima Masanori Aihara Yukitaka Tanaka Tohru Shibazaki Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery Interdisciplinary Neurosurgery Vestibular schwannoma Cost effectiveness Wait and scan Radiosurgery |
| title | Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery |
| title_full | Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery |
| title_fullStr | Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery |
| title_full_unstemmed | Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery |
| title_short | Cost-effectiveness analysis of treatment for Koos 2 and 3 vestibular schwannomas: Wait & scan or radiosurgery |
| title_sort | cost effectiveness analysis of treatment for koos 2 and 3 vestibular schwannomas wait amp scan or radiosurgery |
| topic | Vestibular schwannoma Cost effectiveness Wait and scan Radiosurgery |
| url | http://www.sciencedirect.com/science/article/pii/S2214751921001481 |
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