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Reanalysis of Unruptured Intracranial Aneurysm Management

Effect of a New International Study on the Threshold Probabilities

Information Research and Planning, Baylor College of Medicine, Houston, Texas, Department of General Medicine and Clinical Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

J. Robert Beck, MD

Information Research and Planning, Baylor College of Medicine, Houston, Texas

Takao Kitahara, MD

Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan

Sadayoshi Ohbu, MD

Department of Neurology, Yokohama Municipal Citizen’s Hospital, Kanagawa, Japan

Kazui Soma, MD

Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan

Takashi Ohwada, MD

Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Kanagawa, Japan

Richard W. Cone, MD

Information Research and Planning, Baylor College of Medicine, Houston, Texas

Tsuguya Fukui, MD

Department of General Medicine and Clinical Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Objective. This report updates previous clinical decision analysis for patients with unruptured intracranial aneurysm (UN-AN) based on newly published data and discusses the role of reanalysis in individual decision making. Methods. The authors employed probabilities for the natural history of UN-AN and results of preventive surgery based on the report by the International Study of Unruptured Intracranial Aneurysms. Probabilistic sensitivity analysis with Monte Carlo simulation and traditional n-way sensitivity analyses were used to assess the uncertainty of clinical decisions. Results. The baseline decision in favor of preventive surgery is reversed by new data from the international study. Probabilistic sensitivity analyses revealed several populations showing heterogeneity in terms of strategy selection. One- and two-way sensitivity analyses detected two important factors for decision making: annual rupture rate and utility for knowingly living with UN-AN. Conclusions. Annual UN-AN rupture rate and the utility for knowingly living with UN-AN are key factors when deciding on a therapeutic strategy. Also, updating published decision analyses can improve clinical decision making by integrating clinical judgment and newly available clinical data.

Key Words: clinical decision analysis • Markov model • unruptured intracranial aneurysm • update of decision analysis • evidence-based medicine

Medical Decision Making, Vol. 21, No. 2, 87-96 (2001)
DOI: 10.1177/0272989X0102100201


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