Reanalysis of unruptured intracranial aneurysm management: effect of a new international study on the threshold probabilities.
OBJECTIVE
This report updates previous clinical decision analysis for patients with unruptured intracranial aneurysm (UN-AN) based on newly published data and discusses the role of reanalysis in individual decision making.


METHODS
The authors employed probabilities for the natural history of UN-AN and results of preventive surgery based on the report by the International Study of Unruptured Intracranial Aneurysms. Probabilistic sensitivity analysis with Monte Carlo simulation and traditional n-way sensitivity analyses were used to assess the uncertainty of clinical decisions.


RESULTS
The baseline decision in favor of preventive surgery is reversed by new data from the international study. Probabilistic sensitivity analyses revealed several populations showing heterogeneity in terms of strategy selection. One- and two-way sensitivity analyses detected two important factors for decision making: annual rupture rate and utility for knowingly living with UN-AN.


CONCLUSIONS
Annual UN-AN rupture rate and the utility for knowingly living with UN-AN are key factors when deciding on a therapeutic strategy. Also, updating published decision analyses can improve clinical decision making by integrating clinical judgment and newly available clinical data.
Aoki
N
N
Information Research and Planning, Baylor College of Medicine, Houston, Texas, USA. naoki@bcm.tmc.edu
Beck
J R
JR
Kitahara
T
T
Ohbu
S
S
Soma
K
K
Ohwada
T
T
Cone
R W
RW
Fukui
T
T
D000328:Adult; D003661:Decision Support Techniques; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D009010:Monte Carlo Method; D011183:Postoperative Complications; D011336:Probability; D019057:Quality-Adjusted Life Years