{"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":1789105087565,"version":"build-2803163510"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,11]]},"abstract":"\n Object<\/jats:title>\n Vestibular schwannomas (VSs) are managed in 3 ways: observation (\u201cwait and scan\u201d); Gamma Knife surgery (GKS); or microsurgery. Whereas there is considerable literature regarding which management approach is superior, there are only a few studies addressing the cost of treating VSs, and there are no cost-utility analyses in the US to date.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this study, the authors used the University of California at San Francisco medical record and hospital accounting databases to determine total hospital charges and costs for 33 patients who underwent open surgery, 42 patients who had GKS, and 12 patients who were observed between 2010 and 2013. The authors then performed decision-tree analysis to determine which treatment paradigm produces the highest quality-adjusted life years and to calculate the incremental cost-effectiveness ratio, depending on the patient's age at VS diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The average total hospital cost over a 3-year period for surgically treated patients was $80,074 (\u00b1 $49,678) versus $9737 (\u00b1 $5522) for patients receiving radiosurgery and $1746 (\u00b1 $2792) for patients who were observed. When modeling the most debilitating symptoms and worst outcomes of VSs (vertigo and death) at different ages at diagnosis, radiation is dominant to observation at all ages up to 70 years. Surgery is cost-effective when compared with radiation (incremental cost-effectiveness ratio < $150,000) at younger ages at diagnosis (< 45 years old).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this model, surgery is a cost-effective alternative to radiation when VS is diagnosed in patients at < 45 years. For patients \u2265 45 years, radiation is the most cost-effective treatment option.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.8.focus14435","type":"journal-article","created":{"date-parts":[[2014,11,1]],"date-time":"2014-11-01T04:36:15Z","timestamp":1414816575000},"page":"E8","source":"Crossref","is-referenced-by-count":36,"title":["Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation"],"prefix":"10.3171","volume":"37","author":[{"given":"Corinna C.","family":"Zygourakis","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taemin","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew Z.","family":"Sun","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Barani","sequence":"additional","affiliation":[{"name":"Radiation Oncology, University of California at San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Parsa","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14435","series-title":"J Neurosurg","first-page":"1220","article-title":"Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma","volume":"108","author":"Banerjee","year":"2008"},{"key":"b2-focus14435","series-title":"Time Magazine","first-page":"16","article-title":"Bitter pill: why medical bills are killing us","author":"Brill","year":"2013"},{"key":"b3-focus14435","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"130","article-title":"Benefit and quality of life after bone-anchored hearing aid fitting in children with unilateral or bilateral hearing impairment","volume":"137","author":"de Wolf","year":"2011"},{"key":"b4-focus14435","series-title":"Arch Intern Med","first-page":"1506","article-title":"Outcomes and cost of coronary artery bypass graft surgery in the United States and Canada","volume":"165","author":"Eisenberg","year":"2005"},{"key":"b5-focus14435","series-title":"Ann Intern Med","first-page":"102","article-title":"The distinction between cost and charges","volume":"96","author":"Finkler","year":"1982"},{"key":"b6-focus14435","series-title":"Clin Otolaryngol","first-page":"22","article-title":"Conservative management, surgery and radiosurgery for treatment of vestibular schwannomas: a model-based approach to costeffectiveness","volume":"39","author":"Gait","year":"2014"},{"key":"b7-focus14435","series-title":"Fam Pract","first-page":"137","article-title":"Economic evaluation of early administration of prednisolone and\/or aciclovir for the treatment of Bell's palsy","volume":"26","author":"Hern\u00e1ndez","year":"2009"},{"key":"b8-focus14435","series-title":"Deaths: Preliminary Data for 2011","author":"Hoyert"},{"key":"b9-focus14435","series-title":"Otol Neurotol","first-page":"86","article-title":"Does patientperceived handicap correspond to the modified clinical test for the sensory interaction on balance?","volume":"27","author":"Loughran","year":"2006"},{"key":"b10-focus14435","series-title":"Otol Neurotol","first-page":"230","article-title":"Conservative management versus stereotactic radiation for vestibular schwannomas: a meta-analysis of patients with more than 5 years' follow-up","volume":"33","author":"Maniakas","year":"2012"},{"key":"b11-focus14435","series-title":"Otol Neurotol","first-page":"1611","article-title":"Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years' follow-up","volume":"33","author":"Maniakas","year":"2012"},{"issue":"3","key":"b12-focus14435","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Incidental vestibular schwannomas: a review of prevalence, growth rate, and management challenges","volume":"33","author":"Schmidt","year":"2012"},{"issue":"3","key":"b13-focus14435","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005\u20132009)","volume":"33","author":"Sonig","year":"2012"},{"key":"b14-focus14435","series-title":"Clin Otolaryngol","first-page":"438","article-title":"Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma","volume":"34","author":"Verma","year":"2009"},{"key":"b15-focus14435","series-title":"J Neurosurg","first-page":"400","article-title":"Decision analysis of treatment options for vestibular schwannoma. 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