Stockdale David, McFerran Don, Brazier Peter, Pritchard Clive, Kay Tony, Dowrick Christopher, Hoare Derek J
British Tinnitus Association, Ground Floor, Unit 5, Acorn Business Park, Woodseats Close, Sheffield, S8 0TB, UK.
Colchester Hospital University NHS Foundation Trust, Lexden Rd, Colchester Essex, CO3 3NB, UK.
BMC Health Serv Res. 2017 Aug 22;17(1):577. doi: 10.1186/s12913-017-2527-2.
There is no standard treatment pathway for tinnitus patients in the UK. Possible therapies include education and reassurance, cognitive behavioural therapies, modified tinnitus retraining therapy (education and sound enrichment), or amplification of external sound using hearing aids. However, the effectiveness of most therapies is somewhat controversial. As health services come under economic pressure to deploy resources more effectively there is an increasing need to demonstrate the value of tinnitus therapies, and how value may be continuously enhanced. The objective of this project was to map out existing clinical practice, estimate the NHS costs associated with the management approaches used, and obtain initial indicative estimates of cost-effectiveness.
Current treatment pathways, costs and health outcomes were determined from the tinnitus literature, national statistics, a patient survey, and expert opinion. These were used to create an Excel-based economic model of therapy options for tinnitus patients. The probabilities associated with the likelihood of an individual patient receiving a particular combination of therapies was used to calculate the average cost of treatment per patient, average health outcome per patient measured in QALYs gained, and cost-effectiveness, measured by the average cost per QALY gained.
The average cost of tinnitus treatment per patient per year is GB£717, equating to an NHS healthcare bill of GB£750 million per year. Across all pathways, tinnitus therapy costs £10,600 per QALY gained. Results were relatively insensitive to restrictions on access to cognitive behaviour therapy, and a subsequent reliance on other therapies.
NHS provisions for tinnitus are cost-effective against the National Institute for Health and Care Excellence cost-effective threshold. Most interventions help, but education alone offers very small QALY gains. The most cost-effective therapies in the model were delivered within audiology.
在英国，耳鸣患者没有标准的治疗途径。可能的治疗方法包括教育与安抚、认知行为疗法、改良耳鸣再训练疗法（教育与声音增强），或使用助听器放大外部声音。然而，大多数治疗方法的有效性存在一定争议。随着医疗服务面临更有效地配置资源的经济压力，越来越需要证明耳鸣治疗方法的价值，以及如何持续提高其价值。本项目的目的是梳理现有临床实践，估算与所采用的管理方法相关的英国国家医疗服务体系（NHS）成本，并获得成本效益的初步指示性估计。
从耳鸣文献、国家统计数据、患者调查和专家意见中确定当前的治疗途径、成本和健康结果。这些被用于创建一个基于Excel的耳鸣患者治疗方案经济模型。与个体患者接受特定治疗组合可能性相关的概率，用于计算每位患者的平均治疗成本、以获得的质量调整生命年（QALYs）衡量的每位患者的平均健康结果，以及以每获得一个QALY的平均成本衡量的成本效益。
每位耳鸣患者每年的平均治疗成本为717英镑，相当于NHS每年7.5亿英镑的医疗费用账单。在所有治疗途径中，耳鸣治疗每获得一个QALY的成本为10,600英镑。结果对认知行为疗法获取受限以及随后对其他疗法的依赖相对不敏感。
NHS对耳鸣的治疗措施相对于英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence）的成本效益阈值具有成本效益。大多数干预措施都有帮助，但仅教育带来的QALY增益非常小。该模型中最具成本效益的治疗方法是在听力学领域提供的。
