title: Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation.
abstract: OBJECTIVE
  Vestibular schwannomas (VSs) are managed in 3 ways: observation ("wait and scan"); Gamma Knife surgery (GKS); or microsurgery. Whereas there is considerable literature regarding which management approach is superior, there are only a few studies addressing the cost of treating VSs, and there are no cost-utility analyses in the US to date.
  
  
  METHODS
  In this study, the authors used the University of California at San Francisco medical record and hospital accounting databases to determine total hospital charges and costs for 33 patients who underwent open surgery, 42 patients who had GKS, and 12 patients who were observed between 2010 and 2013. The authors then performed decision-tree analysis to determine which treatment paradigm produces the highest quality-adjusted life years and to calculate the incremental cost-effectiveness ratio, depending on the patient's age at VS diagnosis.
  
  
  RESULTS
  The average total hospital cost over a 3-year period for surgically treated patients was $80,074 (± $49,678) versus $9737 (± $5522) for patients receiving radiosurgery and $1746 (± $2792) for patients who were observed. When modeling the most debilitating symptoms and worst outcomes of VSs (vertigo and death) at different ages at diagnosis, radiation is dominant to observation at all ages up to 70 years. Surgery is cost-effective when compared with radiation (incremental cost-effectiveness ratio < $150,000) at younger ages at diagnosis (< 45 years old).
  
  
  CONCLUSIONS
  In this model, surgery is a cost-effective alternative to radiation when VS is diagnosed in patients at < 45 years. For patients ≥ 45 years, radiation is the most cost-effective treatment option.
authors.affiliation: Departments of Neurological Surgery and.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: Department of Neurological Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Taemin
authors.initials: T
authors.lastname: Oh
authors.affiliation: Departments of Neurological Surgery and.
authors.forename: Matthew Z
authors.initials: MZ
authors.lastname: Sun
authors.affiliation: Radiation Oncology, University of California at San Francisco;
authors.forename: Igor
authors.initials: I
authors.lastname: Barani
authors.affiliation: Department of Epidemiology and Biostatistics, Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, California; and.
authors.forename: James G
authors.initials: JG
authors.lastname: Kahn
authors.affiliation: Department of Neurological Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods*; D003663:Decision Trees; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000191:economics* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000191:economics*; D016634:Radiosurgery / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
keywords: CAD = Canadian dollars; GKS = Gamma Knife surgery; ICER = incremental cost-effectiveness ratio; NIS = Nationwide Inpatient Sample; NPV = net present value; OR = operating room; PT/OT/RT = physical therapy/occupational therapy/respiratory therapy; QALYs = quality-adjusted life years; UCSF = University of California at San Francisco; VS = vestibular schwannoma; acoustic neuroma; cost-utility analysis; surgery; vestibular schwannoma