PMID- 30864276 OWN - NLM STAT- MEDLINE DCOM- 20200803 LR - 20210109 IS - 1749-4486 (Electronic) IS - 1749-4478 (Print) IS - 1749-4478 (Linking) VI - 44 IP - 4 DP - 2019 Jul TI - In search of the most cost-effective monitoring strategy for vestibular schwannoma: A decision analytical modelling study. PG - 525-533 LID - 10.1111/coa.13326 [doi] AB - 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 euro6526 (95% CI 5923-7058) and euro9429 (95% CI 9197-9643) per patient, respectively. Lifelong annual monitoring provided the best value with a NMB of euro363 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. CI - (c) 2019 The Authors. Clinical Otolaryngology Published by John Wiley & Sons Ltd. FAU - Scholte, Mirre AU - Scholte M AUID- ORCID: 0000-0003-3102-6011 AD - Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. FAU - Hentschel, Mayke A AU - Hentschel MA AUID- ORCID: 0000-0001-6106-089X AD - Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. FAU - Hannink, Gerjon AU - Hannink G AD - Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. FAU - Kunst, Henricus P M AU - Kunst HPM AD - Department of Otolaryngology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. AD - Department of Otolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands. FAU - Steens, Stefan C AU - Steens SC AD - Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. FAU - Rovers, Maroeska M AU - Rovers MM AD - Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. AD - Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. FAU - Grutters, Janneke P C AU - Grutters JPC AD - Department of Operating Rooms, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. AD - Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. LA - eng PT - Journal Article DEP - 20190411 PL - England TA - Clin Otolaryngol JT - Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery JID - 101247023 SB - IM MH - *Cost-Benefit Analysis MH - *Decision Support Techniques MH - Disease Progression MH - Humans MH - Neuroma, Acoustic/*economics/*pathology MH - Population Surveillance/*methods MH - Quality-Adjusted Life Years PMC - PMC6850121 OTO - NOTNLM OT - acoustic neuroma OT - cost-effectiveness analysis OT - magnetic resonance imaging OT - monitoring OT - vestibular schwannoma OT - wait and scan COIS- There are no conflicts of interest. EDAT- 2019/03/14 06:00 MHDA- 2020/08/04 06:00 PMCR- 2019/11/12 CRDT- 2019/03/14 06:00 PHST- 2018/10/29 00:00 [received] PHST- 2019/02/19 00:00 [revised] PHST- 2019/03/08 00:00 [accepted] PHST- 2019/03/14 06:00 [pubmed] PHST- 2020/08/04 06:00 [medline] PHST- 2019/03/14 06:00 [entrez] PHST- 2019/11/12 00:00 [pmc-release] AID - COA13326 [pii] AID - 10.1111/coa.13326 [doi] PST - ppublish SO - Clin Otolaryngol. 2019 Jul;44(4):525-533. doi: 10.1111/coa.13326. Epub 2019 Apr 11.