Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
Clin Otolaryngol. 2009 Oct;34(5):438-46. doi: 10.1111/j.1749-4486.2009.02016.x.
To determine whether economic costs associated with a conservative management strategy for unilateral acoustic neuroma offer an economic advantage over active management options.
Cost and sensitivity analysis on a prospective cohort.
Single centre study within a tertiary referral centre in Toronto, Canada.
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 15 mm in the cerebellopontine angle), patient preference and/or significant co-morbidity.
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.
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.
Cost analysis within the Canadian health care system determined the mean total cost per patient for microsurgical removal at CAD$22,402 (12,545 pounds; 14,561 euros), for gamma knife radiotherapy at CAD$27659 (15,489 pounds; 17,978 euros), for LINAC radiotherapy at CAD$9,003(5,041 pounds; 5,852 euros) and for conservative management at CAD$9,651 (5,405 pounds;6,273 euros) over the follow-up timeframe.
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.
确定单侧听神经瘤的保守管理策略相关的经济成本是否优于积极管理方案。
前瞻性队列的成本和敏感性分析。
加拿大多伦多一家三级转诊中心的单中心研究。
72 名年龄在 36 至 78 岁的单侧听神经瘤患者（32 名男性，40 名女性）最初被分配到保守管理策略。纳入标准为肿瘤体积较小（小脑脑桥角小于 15 毫米）、患者偏好和/或严重合并症。
MRI 扫描在第一年每 6 个月进行一次，随后每年进行一次，随后根据需要每 2-3 年进行一次。临床复查每 6 个月进行一次。保守治疗失败导致积极治疗。
进行成本分析，以确定在随访期间继续保守管理的每位患者的平均总成本与每位接受积极干预的患者的平均前期总成本相比。
在加拿大医疗保健系统中进行的成本分析确定了每位患者接受显微镜手术切除的平均总成本为 22402 加元（12545 英镑；14561 欧元），每位患者接受伽玛刀放射治疗的平均总成本为 27659 加元（15489 英镑；17978 欧元），每位患者接受直线加速器放射治疗的平均总成本为 9003 加元（5041 英镑；5852 欧元），每位患者接受保守治疗的平均总成本为 9651 加元（5405 英镑；6273 欧元）在随访期间。
如果在观察期间肿瘤生长没有导致积极治疗并发症增加，可以证明与显微镜手术切除和伽玛刀放射治疗相比，保守治疗听神经瘤具有经济优势。
