{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:17:27Z","timestamp":1788286647891,"version":"build-2803163510"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Management of unruptured intracranial aneurysms in patients aged 80 years and older remains uncertain because treatment morbidity, rupture risk, post-rupture outcome, and competing mortality interact. We constructed a competing-risk Markov decision model comparing observation with endovascular coiling in Korean patients at index ages 80, 85, and 90 years; microsurgical clipping and stent-assisted coiling or flow diversion served as additional scenarios. The primary outcome was the undiscounted lifetime cumulative incidence of aneurysm- or treatment-attributable events\u2014treatment morbidity, treatment death, rupture death, or rupture poor outcome\u2014counted as a first-event composite in which all four components carry equal weight regardless of severity, duration, or reversibility. Periprocedural coiling morbidity and mortality were anchored to a U.S. National Inpatient Sample analysis from 2001\u20132008, and residual post-treatment rupture risk was fixed at 10% of the natural-history rate. Under this original endpoint, median differences favored observation in every age-90 panel and in all male panels at age\u2009\u2265\u200985, and favored coiling in selected age-80 panels and selected age-85 female panels; the probability that coiling was favored ranged from 0.000 to 0.984. A 24-panel, 3%-discounted severity-weighted quality-adjusted analysis was added, together with structural sensitivities for treatment-morbidity recovery, residual rupture risk, and coiling morbidity. Across 30 endpoint-direction comparisons, with each Ma panel mapped to its two legacy marginals, 21 were concordant; all nine discordant comparisons shifted from observation toward coiling, and eight had 95% quality-adjusted uncertainty intervals spanning zero. Median-direction changes under the executed structural sensitivities were confined to modified Rankin Scale-based panels with reference quality-adjusted differences near zero and uncertainty intervals spanning zero. Modeled treatment preference was therefore conditional on endpoint definition and key structural assumptions, including historical treatment-risk estimates and uncalibrated residual post-treatment rupture risk; these model outputs do not establish treatment recommendations for individual patients.<\/jats:p>","DOI":"10.1371\/journal.pone.0357374","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:51:28Z","timestamp":1788285088000},"page":"e0357374","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Observation versus coiling for unruptured intracranial aneurysms in octogenarians: A decision-analytic modeling study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1381-2000","authenticated-orcid":true,"given":"Hyun Dong","family":"Yoo","sequence":"first","affiliation":[{"name":"Eulji University Hospital, Eulji University College of Medicine","place":["Daejeon, Republic of Korea"],"department":["Department of Neurosurgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Guk","family":"Kim","sequence":"additional","affiliation":[{"name":"Eulji University Hospital, Eulji University College of Medicine","place":["Daejeon, Republic of Korea"],"department":["Department of Neurology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Young","family":"Chung","sequence":"additional","affiliation":[{"name":"Eulji University Hospital, Eulji University College of Medicine","place":["Daejeon, Republic of Korea"],"department":["Department of Neurosurgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"5","key":"pone.0357374.ref001","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1161\/STROKEAHA.110.607986","article-title":"Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001-2008","volume":"42","author":"W Brinjikji","year":"2011","journal-title":"Stroke"},{"issue":"11","key":"pone.0357374.ref002","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1007\/s00701-021-04985-y","article-title":"Treatment of octogenarians and nonagenarians with aneurysmal subarachnoid hemorrhage: a 17-year institutional analysis","volume":"163","author":"JS Catapano","year":"2021","journal-title":"Acta Neurochir (Wien)"},{"issue":"2","key":"pone.0357374.ref003","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3171\/2018.3.JNS173057","article-title":"Long-term outcomes among octogenarians with aneurysmal subarachnoid hemorrhage","volume":"131","author":"H Dasenbrock","year":"2018","journal-title":"J Neurosurg"},{"issue":"12","key":"pone.0357374.ref004","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1161\/STROKEAHA.118.022869","article-title":"Survival and Outcome After Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Elderly Patients","volume":"49","author":"J Goldberg","year":"2018","journal-title":"Stroke"},{"key":"pone.0357374.ref005","article-title":"Improved Outcomes Among Octogenarians with Ruptured Aneurysms: Endovascular Treatment as Right-of-First-Refusal in the Second Post-trial Decade","volume":"190","author":"L Ma","year":"2024","journal-title":"World Neurosurg"},{"issue":"6","key":"pone.0357374.ref006","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.jval.2012.06.012","article-title":"Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1","volume":"15","author":"JJ Caro","year":"2012","journal-title":"Value Health"},{"issue":"6","key":"pone.0357374.ref007","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.jval.2012.06.016","article-title":"Conceptualizing a model: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--2","volume":"15","author":"M Roberts","year":"2012","journal-title":"Value Health"},{"issue":"6","key":"pone.0357374.ref008","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.jval.2012.06.014","article-title":"State-transition modeling: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--3","volume":"15","author":"U Siebert","year":"2012","journal-title":"Value Health"},{"issue":"6","key":"pone.0357374.ref009","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jval.2012.04.014","article-title":"Model parameter estimation and uncertainty: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--6","volume":"15","author":"AH Briggs","year":"2012","journal-title":"Value Health"},{"issue":"6","key":"pone.0357374.ref010","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jval.2012.04.012","article-title":"Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--7","volume":"15","author":"DM Eddy","year":"2012","journal-title":"Value Health"},{"issue":"36","key":"pone.0357374.ref011","doi-asserted-by":"crossref","DOI":"10.3310\/hta8360","article-title":"Review of guidelines for good practice in decision-analytic modelling in health technology assessment","volume":"8","author":"Z Philips","year":"2004","journal-title":"Health Technol Assess"},{"key":"pone.0357374.ref012","author":"Statistics Korea","year":"2024"},{"issue":"21","key":"pone.0357374.ref013","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1212\/WNL.0000000000002149","article-title":"Risk of rupture of unruptured cerebral aneurysms in elderly patients","volume":"85","author":"T Hishikawa","year":"2015","journal-title":"Neurology"},{"issue":"1","key":"pone.0357374.ref014","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jval.2021.11.1351","article-title":"Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"25","author":"D Husereau","year":"2022","journal-title":"Value Health"},{"key":"pone.0357374.ref015","doi-asserted-by":"crossref","first-page":"1281457","DOI":"10.3389\/fpubh.2023.1281457","article-title":"Health-related quality of life of Korean older adults according to age, sex, and living arrangements: a cross-sectional study","volume":"11","author":"HA Hwang","year":"2023","journal-title":"Front Public Health"},{"issue":"2","key":"pone.0357374.ref016","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s11136-025-04114-7","article-title":"Utility-weighted modified Rankin scale scores in patients with ischemic stroke: a multicenter observational study","volume":"35","author":"F Irie","year":"2026","journal-title":"Qual Life Res"},{"issue":"4","key":"pone.0357374.ref017","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s11547-023-01620-x","article-title":"Utility of virtual stenting in treatment of cerebral aneurysms by flow diverter devices","volume":"128","author":"F Briganti","year":"2023","journal-title":"Radiol Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357374","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:51:33Z","timestamp":1788285093000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0357374"}},"subtitle":[],"editor":[{"given":"Mario","family":"Tortora","sequence":"first","affiliation":[{"name":"Universit\u00e0 degli Studi di Napoli Federico II: Universita degli Studi di Napoli Federico II","place":["ITALY"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":17,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0357374","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}