In Search of the Most Cost-effective Monitoring Strategy for Vestibular Schwannoma: A Decision Analytical Modelling Study

Overview

Journal Clin Otolaryngol

Specialty Otorhinolaryngology

Date 2019 Mar 14

PMID 30864276

Citations 5

Authors

Mirre Scholte

Mayke A Hentschel

Gerjon Hannink

Henricus P M Kunst

Stefan C Steens

Maroeska M Rovers

Janneke P C Grutters

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess the cost-effectiveness of frequently used monitoring strategies for vestibular schwannoma (VS).

Design: A state transition model was developed to compare six monitoring strategies for patients with VS: lifelong annual monitoring; annual monitoring for the first 10 years after diagnosis; scanning at 1-5, 7, 9, 12, 15 years after diagnosis and subsequently every 5 years; a personalised monitoring strategy for small and large tumours; scanning at 1, 2 and 5 years after diagnosis and no monitoring. Input data were derived from literature and expert opinion. Quality-adjusted life years (QALYs) and healthcare costs of each strategy were modelled over lifetime. Net monetary benefits (NMBs) were calculated to determine which strategy provided most value for money. Sensitivity analyses were performed to address uncertainty.

Results: Omitting monitoring is least effective with 18.23 (95% CI 16.84-19.37) QALYs per patient, and lifelong annual monitoring is most effective with 18.66 (95% CI 17.42-19.65) QALYs. Corresponding costs were €6526 (95% CI 5923-7058) and €9429 (95% CI 9197-9643) per patient, respectively. Lifelong annual monitoring provided the best value with a NMB of €363 765 (339 040-383 697), but the overall probability of being most cost-effective compared to the other strategies was still only 23%. Sensitivity analysis shows that there is large uncertainty in the effectiveness of all strategies, with largely overlapping 95% confidence intervals for all strategies.

Conclusions: Due to the largely overlapping 95% confidence intervals of all monitoring strategies for VS, it is unclear which monitoring strategy provides most value for money at this moment.

Citing Articles

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Auditory brainstem response prior to MRI compared to standalone MRI in the detection of vestibular schwannoma: A modelling study.

Wijn S, Hentschel M, Beynon A, Kunst H, Rovers M Clin Otolaryngol. 2021; 47(2):295-303.

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The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review.

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Development of a model to predict vestibular schwannoma growth: An opportunity to introduce new wait and scan strategies.

Hentschel M, Hannink G, Steens S, Mulder J, Rovers M, Kunst H Clin Otolaryngol. 2020; 46(1):273-283.

PMID: 33090707 PMC: 7821120. DOI: 10.1111/coa.13661.

In search of the most cost-effective monitoring strategy for vestibular schwannoma: A decision analytical modelling study.

Scholte M, Hentschel M, Hannink G, Kunst H, Steens S, Rovers M Clin Otolaryngol. 2019; 44(4):525-533.

PMID: 30864276 PMC: 6850121. DOI: 10.1111/coa.13326.

References

Hentschel M, Rovers M, Markodimitraki L, Steens S, Kunst H . An international comparison of diagnostic and management strategies for vestibular schwannoma. Eur Arch Otorhinolaryngol. 2018; 276(1):71-78. PMC: 6338706. DOI: 10.1007/s00405-018-5199-6. View

Scholte M, Hentschel M, Hannink G, Kunst H, Steens S, Rovers M . In search of the most cost-effective monitoring strategy for vestibular schwannoma: A decision analytical modelling study. Clin Otolaryngol. 2019; 44(4):525-533. PMC: 6850121. DOI: 10.1111/coa.13326. View

Conley G, Hirsch B . Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes. Curr Opin Otolaryngol Head Neck Surg. 2010; 18(5):351-6. DOI: 10.1097/MOO.0b013e32833c71a2. View

Hajioff D, Raut V, Walsh R, Bath A, Bance M, Guha A . Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol. 2008; 33(3):255-9. DOI: 10.1111/j.1749-4486.2008.01705.x. View

Wolbers J, Dallenga A, van Linge A, Te West M, Kummer E, Mendez Romero A . Identifying at diagnosis the vestibular schwannomas at low risk of growth in a long-term retrospective cohort. Clin Otolaryngol. 2016; 41(6):788-792. DOI: 10.1111/coa.12661. View

Vemer P, Corro Ramos I, van Voorn G, Al M, Feenstra T . AdViSHE: A Validation-Assessment Tool of Health-Economic Models for Decision Makers and Model Users. Pharmacoeconomics. 2015; 34(4):349-61. PMC: 4796331. DOI: 10.1007/s40273-015-0327-2. View

Pan P, Huang J, Morioka C, Hathout G, El-Saden S . Cost analysis of vestibular schwannoma screening with contrast-enhanced magnetic resonance imaging in patients with asymmetrical hearing loss. J Laryngol Otol. 2015; 130(1):21-4. DOI: 10.1017/S0022215115002431. View

Klijn S, Verheul J, Beute G, Leenstra S, Mulder J, Kunst H . Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands. J Neurosurg. 2015; 124(6):1619-26. DOI: 10.3171/2015.4.JNS142415. View

Mindermann T, Schlegel I . Grading of vestibular schwannomas and corresponding tumor volumes: ramifications for radiosurgery. Acta Neurochir (Wien). 2012; 155(1):71-4. DOI: 10.1007/s00701-012-1553-4. View

10.

Ara R, Brazier J . Deriving an algorithm to convert the eight mean SF-36 dimension scores into a mean EQ-5D preference-based score from published studies (where patient level data are not available). Value Health. 2008; 11(7):1131-43. DOI: 10.1111/j.1524-4733.2008.00352.x. View

11.

Godefroy W, Hastan D, van der Mey A . Translabyrinthine surgery for disabling vertigo in vestibular schwannoma patients. Clin Otolaryngol. 2007; 32(3):167-72. DOI: 10.1111/j.1365-2273.2007.01427.x. View

12.

Godefroy W, van der Mey A, de Bruine F, Hoekstra E, Malessy M . Surgery for large vestibular schwannoma: residual tumor and outcome. Otol Neurotol. 2009; 30(5):629-34. DOI: 10.1097/MAO.0b013e3181a8651f. View

13.

Whitmore R, Urban C, Church E, Ruckenstein M, Stein S, Lee J . Decision analysis of treatment options for vestibular schwannoma. J Neurosurg. 2010; 114(2):400-13. DOI: 10.3171/2010.3.JNS091802. View

14.

Ware Jr J . SF-36 health survey update. Spine (Phila Pa 1976). 2000; 25(24):3130-9. DOI: 10.1097/00007632-200012150-00008. View

15.

Morrison D . Management of patients with acoustic neuromas: a Markov decision analysis. Laryngoscope. 2010; 120(4):783-90. DOI: 10.1002/lary.20819. View

16.

Stepanidis K, Kessel M, Caye-Thomasen P, Stangerup S . Socio-demographic distribution of vestibular schwannomas in Denmark. Acta Otolaryngol. 2014; 134(6):551-6. DOI: 10.3109/00016489.2014.890293. View

17.

Carlson M, Link M, Wanna G, Driscoll C . Management of sporadic vestibular schwannoma. Otolaryngol Clin North Am. 2015; 48(3):407-22. DOI: 10.1016/j.otc.2015.02.003. View

18.

Grutters J, Joore M, van der Horst F, Verschuure H, Dreschler W, Anteunis L . Choosing between measures: comparison of EQ-5D, HUI2 and HUI3 in persons with hearing complaints. Qual Life Res. 2007; 16(8):1439-49. PMC: 2039846. DOI: 10.1007/s11136-007-9237-x. View

19.

Erickson N, Schmalz P, Agee B, Fort M, Walters B, McGrew B . Koos Classification of Vestibular Schwannomas: A Reliability Study. Neurosurgery. 2018; 85(3):409-414. DOI: 10.1093/neuros/nyy409. View

20.

Stangerup S, Tos M, Thomsen J, Caye-Thomasen P . True incidence of vestibular schwannoma?. Neurosurgery. 2010; 67(5):1335-40. DOI: 10.1227/NEU.0b013e3181f22660. View