Lifetime Cost and Quality-Adjusted Life-Years Across Management Options for Small- and Medium-Sized Sporadic Vestibular Schwannoma

Abstract

Objective: Despite the growing emphasis on healthcare costs, limited data address this aspect of care within the vestibular schwannoma (VS) literature. We sought to determine which strategy confers the lowest lifetime cost and greatest quality-adjusted life-years (QALYs) for patients with small-to medium-sized sporadic VS tumors. Study Design: A Markov model was created to determine the most cost-effective management algorithm. Tumor characteristics, magnetic resonance imaging surveillance schedule, treatment outcomes, and health-related quality of life values were derived from previously published data. Cost estimates were based on CMS Fee Schedule reimbursement rates. Setting: Economic Evaluation Service within the Kern Center for the Science of Healthcare Delivery. Patients: Patients diagnosed with small-to medium-sized sporadic VS. Interventions: Upfront microsurgery following diagnosis, upfront radiosurgery following diagnosis, observation with microsurgery reserved for observed tumor growth, and observation with radiosurgery reserved for observed tumor growth. Results: Across patient ages at time of diagnosis ranging from 18 to 70 years, observation with subsequent radiosurgery used for tumor growth was the most cost-effective management algorithm while upfront microsurgery was the least.

Price Transparency in the Management of Skull Base Tumors—The Price to Operate

“…In their 2021 study, Macielak et al report that observation with subsequent radiosurgery for tumor growth proved to be the most cost-effective approach, while upfront microsurgery was the least cost-effective in the management of sporadic VS. 13 Additionally, Schnurman et al found that managing tumors with resection leads to significantly higher both initial and follow-up costs compared with using radiosurgery. 14 Thus, if readily available and user-friendly PT information existed, research-backed approaches can be used in conjunction with pricing information to improve the patient quality of life and disease management.…”

Natural History of Serviceable Hearing During Active Surveillance of Nongrowing Sporadic Vestibular Schwannoma Supports Consideration of Initial Wait-and-Scan Management

“…In a motivated and informed patient, upfront microsurgery or radiosurgery is a reasonable consideration, with many experienced centers reporting microsurgery early postoperative hearing preservation rates of over 50% for small tumors (24)(25)(26)(27). Because tumor control and facial nerve function are achieved in most small VS regardless of single modality treatment, the primary considerations in this population are preserving residual functional hearing when present, quality of life, and cost-effectiveness (30,31).…”

Comparing Patient Satisfaction After Upfront Treatment Versus Wait-and-Scan for Small Sporadic Vestibular Schwannoma

“…From a clinical standpoint, these patients avoid or at least delay potential complications associated with surgical and radiosurgical intervention. From a patient standpoint, the wait-andscan approach may be associated with a smaller financial burden and fewer disruptions of work, child care, or social obligations particularly when compared with surgical intervention (27,28). The wait-and-scan approach offers patients an opportunity to accommodate to and reconcile the new diagnosis over time, learn more about the biological behavior of the tumor before considering treatment, and understand more about treatment options, which may alleviate associated anxiety and inform sound decision making regarding tumor management.…”