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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS002169-06
Application #
6740214
Study Section
NST-2 Subcommittee (NST)
Program Officer
Marler, John R
Project Start
2000-05-19
Project End
2007-03-31
Budget Start
2004-04-01
Budget End
2007-03-31
Support Year
6
Fiscal Year
2004
Total Cost
$154,629
Indirect Cost
Name
Yale University
Department
Neurosurgery
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
King Jr, Joseph T; Tsevat, Joel; Roberts, Mark S (2009) Measuring preference-based quality of life using the EuroQol EQ-5D in patients with cerebral aneurysms. Neurosurgery 65:565-72; discussion 572-3
King Jr, Joseph T; Tsevat, Joel; Roberts, Mark S (2009) Impact of the scale upper anchor on health state preferences. Med Decis Making 29:257-66
King Jr, Joseph T; Brandt, Cynthia A; Tsevat, Joel et al. (2009) A national internet-based survey of cerebral aneurysm preference-based quality of life. Neurosurgery 64:249-54; discussion 254-5
King Jr, Joseph T; DiLuna, Michael L; Cicchetti, Domenic V et al. (2006) Cognitive functioning in patients with cerebral aneurysms measured with the mini mental state examination and the telephone interview for cognitive status. Neurosurgery 59:803-10; discussion 810-1
King Jr, Joseph T; Horowitz, Michael B; Bissonette, David J et al. (2006) What do patients with cerebral aneurysms know about their condition? Neurosurgery 58:824-30; discussion 824-30
King Jr, Joseph T; Tsevat, Joel; Roberts, Mark S (2006) The physical performance test and the evaluation of functional status in patients with cerebral aneurysms. J Neurosurg 104:525-30
Stoffman, Michael R; Roberts, Mark S; King Jr, Joseph T (2005) Cervical spondylotic myelopathy, depression, and anxiety: a cohort analysis of 89 patients. Neurosurgery 57:307-13; discussion 307-13
King Jr, Joseph T; Carlier, Patricia M; Marion, Donald W (2005) Early Glasgow Outcome Scale scores predict long-term functional outcome in patients with severe traumatic brain injury. J Neurotrauma 22:947-54
King Jr, Joseph T; Tsevat, Joel; Lave, Judith R et al. (2005) Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation. Med Decis Making 25:667-77
King Jr, J T; Yonas, H; Horowitz, M B et al. (2005) A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons. J Neurol Neurosurg Psychiatry 76:550-4

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