Evaluation of cost effectiveness for conservative and active management strategies for acoustic neuroma.

OBJECTIVE

To determine whether economic costs associated with a conservative management strategy for unilateral acoustic neuroma offer an economic advantage over active management options.

DESIGN

Cost and sensitivity analysis on a prospective cohort.

SETTING

Single centre study within a tertiary referral centre in Toronto, Canada.

PARTICIPANTS

72 patients (32 males, 40 females) aged 36 to 78 years with unilateral acoustic neuroma were assigned initially to a conservative management strategy. Entry criteria were small tumour size (less than 15 mm in the cerebellopontine angle), patient preference and/or significant co-morbidity.

INTERVENTIONS: MRI scanning was performed every 6 months for the first year, annually subsequently and then every 2-3 years as required. Clinical review occurred every 6 months. Failure of conservative management led to active treatment.

MAIN OUTCOME MEASURES: Cost analysis was performed to determine the mean total cost per patient for continued conservative management over the follow up period compared to the mean upfront total cost per patient undergoing active intervention.

RESULTS

Cost analysis within the Canadian health care system determined the mean total cost per patient for microsurgical removal at CAD$22,402 (12,545 pounds; 14,561 euros), for gamma knife radiotherapy at CAD$27659 (15,489 pounds; 17,978 euros), for LINAC radiotherapy at CAD$9,003(5,041 pounds; 5,852 euros) and for conservative management at CAD$9,651 (5,405 pounds;6,273 euros) over the follow-up timeframe.

CONCLUSION

An economic advantage can be demonstrated for the conservative management of acoustic neuromas compared to microsurgical removal and gamma knife radiotherapy on the proviso that no increase in active treatment complications arose from continued tumour growth during the period of observation.