The cost effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of solitary metastatic brain tumors. Commentary.
SOLITARY METASTATIC BRAIN tumors are the most common intracranial neoplasms encountered by neurosurgeons.
Surgical resection of brain metastasis with whole brain radiotherapy (WBR) significantly increases survival in comparison with WBR alone.
Stereotactic radiosurgery (SR) seems to provide results that are similar to those of surgical resection.
To analyze the economic efficiency of these different treatments, we compared the results of surgical resection and SR as reported in the medical literature between 1974 and 1994.
Our analysis revealed that radiosurgery had a lower uncomplicated procedure cost ($20,209 versus $27,587), a lower average complication cost per case ($2,534 versus $2,874), and a lower total cost per procedure ($22,743 versus $30,461), was more cost effective ($24,811 versus $32,149 per life year), and had a better incremental cost effectiveness ($40,648 versus $52,384 per life year) than surgical resection.
A sensitivity analysis revealed that large changes in key assumptions would be required to change the analysis outcome.
Elimination of all surgical resection morbidity cost would still result in superior incremental cost effectiveness for SR.
These results indicate the need for prospective clinical trials that examine both the clinical efficacy and the cost effectiveness of surgical resection and SR in the management of solitary metastatic brain tumors.
Mots-clés Pascal : Tumeur, Intracrânien, Métastase, Résection chirurgicale, Radiochirurgie, Chirurgie stéréotaxique, Analyse coût efficacité, Etude comparative, Traitement, Homme, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Tumeur maligne, Chirurgie, Economie santé
Mots-clés Pascal anglais : Tumor, Intracranial, Metastasis, Surgical resection, Radiosurgery, Stereotaxic surgery, Cost efficiency analysis, Comparative study, Treatment, Human, Nervous system diseases, Central nervous system disease, Cerebral disorder, Malignant tumor, Surgery, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0518746
Code Inist : 002B17E. Création : 01/03/1996.