Re: Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma

Abstract

Objective: To determine whether economic costs associated with a conservative management strategy for unilateral acoustic neuroma offer an economic advantage over active management options. Design: Cost and sensitivity analysis on a prospective cohort. Setting: Single centre study within a tertiary referral centre in Toronto, Canada. Participants: 72 patients (32 males, 40 females) aged 36 to 78 years with unilateral acoustic neuroma were assigned initially to a conservative management strategy. Entry criteria were small tumour size (less than 15mm in the cerebellopontine angle), patient preference and/or significant co-morbidity. Interventions: MRI scanning was performed every 6 months for the first year, annually subsequently and then every 2-3 years as required. Clinical review occurred every 6 months. Failure of conservative management led to active treatment. Main outcome measures: Cost analysis was performed to determine the mean total cost per patient for continued conservative management over the follow up period compared to the mean upfront total cost per patient undergoing active intervention. Results: Cost analysis within the Canadian health care system determined the mean total cost per patient for microsurgical removal at CAD$22,402 (£12,545; 14,561€), for gamma knife radiotherapy at CAD$27659 (£15,489; 17,978€), for LINAC radiotherapy at CAD$9,003(£5,041; 5,852€) and for conservative management at CAD$9,651 (£5,405;6,273€) over the follow-up timeframe. Conclusion: An economic advantage can be demonstrated for the conservative management of acoustic neuromas compared to microsurgical removal and gamma knife radiotherapy on the proviso that no increase in active treatment complications arose from continued tumour growth during the period of observation.