Management of patients with acoustic neuromas: A Markov decision analysis

Morrison, Daniel R.

doi:10.1002/lary.20819

Cited by 29 publications

(19 citation statements)

References 55 publications

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“…3 Recent studies undertake a cost-effectiveness analysis comparing these three approaches. 30,31 Using a Markov decision analysis model, the benefit derived from each management strategy in quality-adjusted life years (QALYs) was measured.…”

Section: Comparison Of Radiotherapy With Other Approachesmentioning

confidence: 99%

Radiotherapy for vestibular schwannoma: Review of recent literature results

Apicella

Paolini

Deantonio

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Section: Comparison Of Radiotherapy With Other Approachesmentioning

confidence: 99%

Radiotherapy for vestibular schwannoma: Review of recent literature results

Apicella

Paolini

Deantonio

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…At NICE, judgements on allocative efficiency typically include assessment of cost per Quality-Adjusted Life Year. 42 It has also been used to guide decisionmaking for patients with acoustic neuroma 43 and for elderly patients with hearing loss. 2 Cost-utility analysis and Quality-Adjusted Life Years calculation are already in use in a variety of ENT settings.…”

Section: Select Methodsmentioning

confidence: 99%

Cost–utility analysis and otolaryngology

et al. 2014

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As providers of health care, we face increasing demand on our limited, indeed diminishing, resources. Economic appraisal of our interventions means assessing the trade-off between effectiveness, efficiency and equity. When rationing becomes inevitable, calculation of utility values is a valuable decision-making tool. This paper reviews objective measures of patient benefit, such as quality of life, and focuses on their application within otolaryngology.

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“…Patients will expectedly benefit from transparency conferred by an impartial decision tool and become highly informed partners in shared medical decision making. Using Markov decision analysis from the societal perspective and the benefit derived from each management strategy in quality-adjusted life years (QALYs) as the main outcome measure, Morrison (2010) 41 found that for patients with small (< 1.5 cm) vestibular schwannomas of all ages, a period of observation during which tumor growth and hearing thresholds are closely monitored was the superior strategy. For tumors that grow substantially or when hearing deteriorates, definitive management via radiosurgery was recommended.…”

Section: Decision Analysismentioning

confidence: 99%

Management of Vestibular Schwannoma: Dependence on Stakeholder's View for Small and Medium-Sized Tumors

Gouveris¹,

Zisiopoulou²,

Mann³

2011

An International Journal of Otorhinolaryngology Clinics

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Management options for patients with vestibular schwannoma include observation and active treatment, namely surgical resection, gamma knife stereotactic radiosurgery or fractionated radiation therapy. Although for large tumors microsurgery remains the mainstay of treatment, management of the small-and medium-sized vestibular schwannomas has been the matter of considerable controversy. Computerized clinical decision support systems have been developed to assist clinicians in this demanding task. Nonetheless, the complexity of the problem requires adaptation of the decision strategy to specific circumstances arising within a particular clinical scenario which can not always be modeled with adequate precision or addressed adequately within a mathematical framework. We present a set of clinical, neurophysiologic and radiologic parameters and the respective evidence which may guide carers' decisions. These parameters include the size, growth rate and localization of the tumor, the age, general medical condition, facial nerve function, hearing and hearing deterioration rate, balance, vestibular and trigeminal nerve function of the affected individual, the estimated risk of malignant transformation and radiation-induced tumors, the health-related quality of life measures, the patient's and surgeon's preference and the issue of cost-effectiveness. A complex decision analysis, guided by evidence and tailored to each individual patient is required.

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Management of patients with acoustic neuromas: A Markov decision analysis

Abstract: For patients of all ages, a period of observation during which tumor growth and hearing thresholds are closely monitored is the superior strategy. For tumors that grow substantially or when hearing deteriorates, definitive management via radiosurgery is recommended.

Cited by 29 publications

References 55 publications

Radiotherapy for vestibular schwannoma: Review of recent literature results

Radiotherapy for vestibular schwannoma: Review of recent literature results

Cost–utility analysis and otolaryngology

Management of Vestibular Schwannoma: Dependence on Stakeholder's View for Small and Medium-Sized Tumors

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