Abstract
ObjectiveVestibular schwannomas are benign slowly growing tumors, with 3 treatment options: wait and scan, radiosurgery, and microsurgery with specific advantages and disadvantages. Contemporary debate has focused on medium size tumor. The present study used a Markov model to try to identify the cost-effectiveness in a lifelong perspective of the “wait & scan” or “radiosurgery” strategies for Koos 2 and 3 tumors. MethodsThe present model was defined by 5 discrete health states. All decision and chance nodes were assigned a probability of occurrence derived from a thorough review of the related literature. We calculated the expected effects and costs associated with the two strategies, then evaluated the incremental cost-effectiveness ratio. Sensitivity analysis was performed by altering the input values within a clinically reasonable range to assess the effects of uncertainties. ResultsRadiosurgery always requires more costs than wait & scan, and seems to generate small effects. However, the incremental cost-effectiveness ratio was significantly influenced by the hazard ratio of risk generated by deferred radiosurgery. One-way and two-way sensitivity analysis indicated that radiosurgery always yields negative effectiveness, compared with wait & scan at hazard ratio of less than 3.0, regardless of any other assumptions. ConclusionsTreatment strategy for medium size vestibular schwannoma should primarily be based on the future increased risk of radiosurgery after failure of conservative management. Wait & scan strategy may be the optimum approach for most Koos 2 and 3 tumors, but relatively large Koos 3 tumors are candidates for immediate radiosurgery.
Published Version
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