{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:00:11Z","timestamp":1781190011117,"version":"3.54.1"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study focuses on epidermal growth factor receptor\u2013mutated lung adenocarcinoma, known for frequent brain metastasis. It aimed to compare the clinical outcomes and cost-effectiveness of combining Gamma Knife radiosurgery (GKRS) with tyrosine kinase inhibitors (TKIs) (GKRS+TKI group) versus TKIs alone (TKI group) for the treatment of patients with newly diagnosed brain metastasis in this condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Study characteristics of the two groups were matched using inverse probability of treatment weighting (IPTW). In the incremental cost-utility ratio (ICUR) model, a healthcare provider perspective, a 1-month cycle length, a 5-year time horizon, and a discount rate of 2% per year for both effectiveness and costs were adopted. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of the findings. Statistical analysis was performed using IBM SPSS version 23.0, and cost-effectiveness analysis was conducted using TreeAge Pro software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>After applying IPTW, the GKRS+TKI group included 205 patients, and the TKI group consisted of 102 patients, with no statistically significant differences in whole confounders. The GKRS+TKI group demonstrated significantly prolonged median progression-free survival (37.5 months vs 10.6 months, p &lt; 0.001) and median overall survival (55.1 months vs 30.8 months, p &lt; 0.001) compared with the TKI group. The GKRS plus TKI strategy achieved an ICUR of $30,532.25 per quality-adjusted life year relative to the TKIs at the willingness-to-pay threshold of US$33,059 (Taiwan\u2019s per capita gross domestic product).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The use of GKRS plus TKIs not only reduces disease recurrence and improves prognosis but also demonstrates a higher level of cost-effectiveness. These findings offer valuable guidelines for clinicians and inform healthcare authorities in optimizing resource allocation for improved medical care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.7.jns24310","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T20:30:22Z","timestamp":1736541022000},"page":"1710-1719","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes and cost-utility analysis of GKRS plus TKIs versus TKIs in patients with EGFR-mutant lung adenocarcinoma and brain metastases: a Markov decision model"],"prefix":"10.3171","volume":"142","author":[{"given":"Szu-Hao Andrew","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung;"},{"name":"Department of Pharmacy and Master Program, Tajen University, Pingtung;"},{"name":"School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Chia","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huai-Che","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Lun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hsien","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Yuh","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung;"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;"},{"name":"Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hon-Yi","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung;"},{"name":"Department of Business Management, National Sun Yat-Sen University, Kaohsiung;"},{"name":"Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung; and"},{"name":"Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Am J Cancer Res","first-page":"3607","article-title":"Clinical outcome analysis of non-small cell lung cancer patients with brain metastasis receiving metastatic brain tumor resection surgery: a multicenter observational study","volume":"13","author":"Hsu PC","year":"2023","unstructured":"Hsu PC, Chiu LC, Chen KT,  Clinical outcome analysis of non-small cell lung cancer patients with brain metastasis receiving metastatic brain tumor resection surgery: a multicenter observational study. 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