THE OPTIMAL MANAGEMENT OF CEREBRAL ANEURYSMS

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DESCRIPTION (Adapted From The Applicant's Abstract): The 1-5% prevalence of cerebral aneurysms implies that 2,000,000 to 10,000,000 adults in the United States may harbor an intracranial aneurysm. Each year 21,000 of these individuals suffer a subarachnoid hemorrhage, resulting in significant morbidity, mortality, and expense. Neurosurgeons make final decisions regarding operative intervention for aneurysm patients. While there is a growing body of data on the natural history, management, and outcomes of cerebral aneurysms, the components of neurosurgical decision-making for aneurysm patients are poorly understood. My long-term objective is to establish a research career targeted at improving neurosurgical decision-making and outcomes in patients with cerebrovascular disease. My immediate goal is to develop a decision analytic and cost-effectiveness computer simulation model to evaluate the outcomes of neurosurgical decisions in patients with cerebral aneurysmsal disease. The study plan includes mentoring by Dr. Mark Roberts (a nationally recognized expert in decision sciences), one-on-one tutorials with a group of supporting advisors, course work, seminars, and directed readings. The specific aims of this proposal are: (1) Construct a computer simulation decision analytic model to examine optimal neurosurgical decision-making in patients with cerebral aneurysms, and (2) Use the computer simulation model to perform a cost effectiveness analysis to optimize societal resource allocation during the management of aneurysm patients. The research component will accomplish these aims via primary collection of patient preference and economic data, secondary data analysis, and mathematical modeling techniques. The proposal will update and greatly expand the my preliminary model to incorporate both unruptured and ruptured aneurysms, actual patient preferences for various outcome states, disease severity-adjustment, recent advances in the understanding of aneurysm natural history, the evolution of treatment technologies, and more detailed economic data. In addition, I will expand my skills and expertise in formal decision sciences and cost-effectiveness analysis through mentored sessions, specific courses, seminars, directed readings, and research work. This proposal builds on my training in neurosurgery and epidemiology and on my current research. The study and research plan should lay the foundation for sustained career development. At the conclusion of this award, I will have gained the experience and research skills to independently investigate and improve neurosurgical decision-making and outcomes in patients with cerebrovascular disease.