Pérez-Martín Jorge, Artaso Miguel A, Díez Francisco J
Department of Artificial Intelligence, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
Laryngoscope. 2017 Dec;127(12):2866-2872. doi: 10.1002/lary.26765. Epub 2017 Aug 4.
OBJECTIVES/HYPOTHESIS: To determine the incremental cost-effectiveness of bilateral versus unilateral cochlear implantation for 1-year-old children suffering from bilateral sensorineural severe to profound hearing loss from the perspective of the Spanish public health system.
Cost-utility analysis.
We conducted a general-population survey to estimate the quality-of-life increase contributed by the second implant. We built a Markov influence diagram and evaluated it for a life-long time horizon with a 3% discount rate in the base case.
The incremental cost-effectiveness ratio of simultaneous bilateral implantation with respect to unilateral implantation for 1-year-old children with severe to profound deafness is €10,323 per quality-adjusted life year (QALY). For sequential bilateral implantation, it rises to €11,733/QALY. Both options are cost-effective for the Spanish health system, whose willingness to pay is estimated at around €30,000/QALY. The probabilistic sensitivity analysis shows that the probability of bilateral implantation being cost-effective reaches 100% for that cost-effectiveness threshold.
Bilateral implantation is clearly cost-effective for the population considered. If possible, it should be done simultaneously (i.e., in one surgical operation), because it is as safe and effective as sequential implantation, and saves costs for the system and for users and their families. Sequential implantation is also cost-effective for children who have received the first implant recently, but it is difficult to determine when it ceases to be so because of the lack of detailed data. These results are specific for Spain, but the model can easily be adapted to other countries.
2C. Laryngoscope, 127:2866-2872, 2017.
目的/假设：从西班牙公共卫生系统的角度，确定双侧与单侧人工耳蜗植入对1岁双侧感音神经性重度至极重度听力损失儿童的增量成本效益。
成本效用分析。
我们进行了一项普通人群调查，以估计第二次植入所带来的生活质量提高。我们构建了一个马尔可夫影响图，并在基本情况下以3%的贴现率对其进行了终身时间范围的评估。
对于重度至极重度耳聋的1岁儿童，同时双侧植入相对于单侧植入的增量成本效益比为每质量调整生命年（QALY）10,323欧元。对于序贯双侧植入，该比值升至11,733欧元/QALY。这两种选择对西班牙卫生系统而言均具有成本效益，其支付意愿估计约为30,000欧元/QALY。概率敏感性分析表明，对于该成本效益阈值，双侧植入具有成本效益的概率达到100%。
对于所考虑的人群，双侧植入显然具有成本效益。如果可能，应同时进行（即一次手术操作），因为它与序贯植入一样安全有效，并且为系统、使用者及其家庭节省成本。对于最近已接受首次植入的儿童，序贯植入也具有成本效益，但由于缺乏详细数据，很难确定何时不再具有成本效益。这些结果是西班牙特有的，但该模型可轻松适用于其他国家。
2C。《喉镜》，2017年，第127卷，第2866 - 2872页。
