title: Reanalysis of unruptured intracranial aneurysm management: effect of a new international study on the threshold probabilities.
abstract: 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.
authors: Information Research and Planning, Baylor College of Medicine, Houston, Texas, USA. naoki@bcm.tmc.edu
authors: N
authors: N
authors: Aoki
authors: J R
authors: JR
authors: Beck
authors: T
authors: T
authors: Kitahara
authors: S
authors: S
authors: Ohbu
authors: K
authors: K
authors: Soma
authors: T
authors: T
authors: Ohwada
authors: R W
authors: RW
authors: Cone
authors: T
authors: T
authors: Fukui
mesh_terms: 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