{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:38:07Z","timestamp":1789105087409,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,2,27]],"date-time":"2014-02-27T00:00:00Z","timestamp":1393459200000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To undertake a cost\u2010effectiveness analysis comparing conservative management, surgery and radiosurgery for treating small\u2010to\u2010medium (1\u201320\u00a0mm)\u2010sized vestibular schwannomas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Model\u2010based economic evaluation using individual\u2010level data from a <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>irmingham\u2010based longitudinal patient database and from published sources. Both a decision tree and state\u2010transition (<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>arkov) model were developed, from an <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ational <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ealth <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ervice (<jats:styled-content style=\"fixed-case\">NHS<\/jats:styled-content>) perspective. Sensitivity analyses were also carried out.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Secondary care treatment for patients with small\u2010to\u2010medium\u2010sized vestibular schwannomas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Three hypothetical cohorts of adult patients receiving conservative management, radiosurgery or surgery treatment, aged 58\u00a0years as starting age within model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Cost\u2010effectiveness based on cost per quality\u2010adjusted life year (<jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Conservative management is the preferred strategy for the treatment of small\u2010to\u2010medium\u2010sized vestibular schwannomas. Conservative management is both cheaper (\u2212\u00a3722 and \u2212\u00a32764) and more effective (0.136 and 0.554 quality\u2010adjusted life years) than both radiosurgery and surgery, respectively. A conservative strategy can therefore be considered as highly cost\u2010effective. This result is sensitive to the assumed quality\u2010of\u2010life parameters in the model. Sensitivity analysis suggests that the probability of a conservative strategy being the most cost\u2010effective approach compared with surgery and radiosurgery at a willingness to pay of \u00a320\u00a0000\/quality\u2010adjusted life year gained is 80% and 55%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A conservative approach is the preferred strategy for treatment of small\u2010to\u2010medium vestibular schwannomas. This result is sensitive to quality\u2010of\u2010life values used in the analysis. More research is required to assess the impact of treatment upon patients\u2019 health\u2010related quality of life over time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12205","type":"journal-article","created":{"date-parts":[[2013,12,7]],"date-time":"2013-12-07T05:08:50Z","timestamp":1386392930000},"page":"22-31","source":"Crossref","is-referenced-by-count":26,"title":["Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model\u2010based approach to cost\u2010effectiveness"],"prefix":"10.1111","volume":"39","author":[{"given":"C.","family":"Gait","sequence":"first","affiliation":[{"name":"Health Economics Unit School of Health and Population Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.J.","family":"Frew","sequence":"additional","affiliation":[{"name":"Health Economics Unit School of Health and Population Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.P.C.","family":"Martin","sequence":"additional","affiliation":[{"name":"ENT Department Worcester Royal Hospital Worcester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Jowett","sequence":"additional","affiliation":[{"name":"Health Economics Unit School of Health and Population Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Irving","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Skull Base Unit Queen Elizabeth Hospital Birmingham West Midlands UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1215\/S1522851705000323"},{"key":"e_1_2_7_3_1","unstructured":"British Association of Otorhinolaryngologists \u2010 Head and Neck Surgeons (BAO\u2010HNS).Clinical Effectiveness Guidelines: Acoustic neuroma (vestibular schwannoma). 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