title: Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model-based approach to cost-effectiveness.
abstract: OBJECTIVE
  To undertake a cost-effectiveness analysis comparing conservative management, surgery and radiosurgery for treating small-to-medium (1-20 mm)-sized vestibular schwannomas.
  
  
  METHODS
  Model-based economic evaluation using individual-level data from a Birmingham-based longitudinal patient database and from published sources. Both a decision tree and state-transition (Markov) model were developed, from an National Health Service (NHS) perspective. Sensitivity analyses were also carried out.
  
  
  METHODS
  Secondary care treatment for patients with small-to-medium-sized vestibular schwannomas.
  
  
  METHODS
  Three hypothetical cohorts of adult patients receiving conservative management, radiosurgery or surgery treatment, aged 58 years as starting age within model.
  
  
  METHODS
  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.
authors: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors: C
authors: C
authors: Gait
authors: E J
authors: EJ
authors: Frew
authors: T P C
authors: TP
authors: Martin
authors: S
authors: S
authors: Jowett
authors: R
authors: R
authors: Irving
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009464:Neuroma, Acoustic / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years