Kosaner Kliess Melodi, Kluibenschaedl Martina, Zoehrer Ruth, Schlick Bettina, Scandurra Francesca, Urban Michael
MED-EL Medical Electronics Ges.m.b.H., Innsbruck, Austria.
MED-EL Medical Electronics Ges.m.b.H., Innsbruck, Austria.
Value Health. 2017 Sep;20(8):1092-1099. doi: 10.1016/j.jval.2017.04.020. Epub 2017 May 31.
Partially implantable active middle ear implants (aMEIs) offer a solution for individuals who have mild to severe sensorineural hearing loss and an outer ear medical condition that precludes the use of hearing aids. When otherwise left untreated, individuals report a lower quality of life, which may further decrease with increasing disability. In the lack of cost-effectiveness studies and long-term data, there is a need for decision modeling.
To explore individual-level variance in resource utilization patterns following aMEI implantation.
A Markov model was developed and analyzed as microsimulation to estimate the incremental cost utility ratio (ICUR) of partially implantable aMEIs compared with no (surgical) intervention in individuals with sensorineural hearing loss and an outer ear medical condition in Australia. Cost data were derived mostly from the Medicare Benefit Schedule and effectiveness data from published literature. A third-party payer perspective was adopted, and a 5% discount rate was applied over a 10-year time horizon.
Compared with baseline strategy, aMEIs yielded an incremental cost of Australian dollars (AUD) 13,339.18, incremental quality-adjusted life-year (QALY) of 1.35, and an ICUR of AUD 9,913.72/QALY. Of the respective number of simulated patients who visited each health state, 75.73% never had a minor adverse event, 99.82% did not experience device failure, and 97.75% did not cease to use their aMEIs. Probabilistic sensitivity analyses showed the ICUR to differ by only 0.95%.
In the Australian setting, partially implantable aMEIs offer a safe and cost-effective solution compared with no intervention and are also well accepted by users.
部分可植入式有源中耳植入物（aMEIs）为患有轻至重度感音神经性听力损失且存在外耳疾病而无法使用助听器的个体提供了一种解决方案。若不进行治疗，个体报告生活质量较低，且随着残疾程度增加，生活质量可能会进一步下降。由于缺乏成本效益研究和长期数据，因此需要进行决策建模。
探讨aMEI植入后资源利用模式的个体水平差异。
开发并分析了一个马尔可夫模型作为微观模拟，以估计在澳大利亚患有感音神经性听力损失和外耳疾病的个体中，部分可植入式aMEIs与不进行（手术）干预相比的增量成本效用比（ICUR）。成本数据主要来自医疗保险福利计划，有效性数据来自已发表的文献。采用第三方支付方视角，并在10年时间范围内应用5%的贴现率。
与基线策略相比，aMEIs产生的增量成本为13339.18澳元，增量质量调整生命年（QALY）为1.35，ICUR为9913.72澳元/QALY。在模拟的访问每个健康状态的患者数量中，75.73%从未发生过轻微不良事件，99.82%未经历设备故障，97.75%未停止使用其aMEIs。概率敏感性分析表明，ICUR仅相差0.95%。
在澳大利亚的情况下，与不进行干预相比，部分可植入式aMEIs提供了一种安全且具有成本效益的解决方案，并且也受到用户的广泛接受。
