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Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model‐based approach to cost‐effectiveness
Author(s) -
Gait C.,
Frew E.J.,
Martin T.P.C.,
Jowett S.,
Irving R.
Publication year - 2014
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.12205
Subject(s) - vestibular schwannomas , medicine , radiosurgery , conservative management , quality of life (healthcare) , conservative treatment , cost–utility analysis , vestibular system , quality adjusted life year , surgery , cost effectiveness , audiology , radiation therapy , risk analysis (engineering) , nursing
Objective To undertake a cost‐effectiveness analysis comparing conservative management, surgery and radiosurgery for treating small‐to‐medium (1–20 mm)‐sized vestibular schwannomas. Design Model‐based economic evaluation using individual‐level data from a B irmingham‐based longitudinal patient database and from published sources. Both a decision tree and state‐transition ( M arkov) model were developed, from an N ational H ealth S ervice ( NHS ) perspective. Sensitivity analyses were also carried out. Setting Secondary care treatment for patients with small‐to‐medium‐sized vestibular schwannomas. Participants Three hypothetical cohorts of adult patients receiving conservative management, radiosurgery or surgery treatment, aged 58 years as starting age within model. Main outcome measures Cost‐effectiveness based on cost per quality‐adjusted life year ( QALY ). Results Conservative management is the preferred strategy for the treatment of small‐to‐medium‐sized vestibular schwannomas. Conservative management is both cheaper (−£722 and −£2764) and more effective (0.136 and 0.554 quality‐adjusted life years) than both radiosurgery and surgery, respectively. A conservative strategy can therefore be considered as highly cost‐effective. This result is sensitive to the assumed quality‐of‐life parameters in the model. Sensitivity analysis suggests that the probability of a conservative strategy being the most cost‐effective approach compared with surgery and radiosurgery at a willingness to pay of £20 000/quality‐adjusted life year gained is 80% and 55%, respectively. Conclusions A conservative approach is the preferred strategy for treatment of small‐to‐medium vestibular schwannomas. This result is sensitive to quality‐of‐life values used in the analysis. More research is required to assess the impact of treatment upon patients’ health‐related quality of life over time.

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