Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan, ROC; Department of Otolaryngology, Pojen General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Mar;81(3):284-290. doi: 10.1016/j.jcma.2017.06.024. Epub 2017 Dec 26.
Health care systems and physicians need to conform to budgets and streamline resources to provide cost-effective quality care. Although endoscopic tympanoplasty (ET) has been performed for decades, no studies on the cost-effectiveness of ET and microscopic tympanoplasty (MT) for treating chronic otitis media have been published. The present study aimed to compare the cost-effectiveness of ET and MT for treating chronic otitis media.
This study was performed using a Cohort-style Markov decision-tree economic model with a 30-year time horizon. The economic perspective was that of a third-party payer (Taiwan National Health Insurance System). Two treatment strategies were compared, namely ET and MT. The primary outcome was the incremental cost per quality-adjusted life year (QALY). Probabilities were obtained from meta-analyses. Costs were obtained from the published literature and Taiwan National Health Insurance System database. Multiple sensitivity analyses were performed to account for data uncertainty.
The reference case revealed that the total cost of ET was $NT 20,901 for 17.08 QALY per patient. By contrast, the total cost of MT was $NT 21,171 for 17.15 QALY per patient. The incremental cost effectiveness ratio for ET versus that of MT was $NT 3703 per QALY. The cost-effectiveness acceptability curve indicated that ET was comparable to MT at a willingness-to-pay threshold of larger than $NT 35,000 per QALY.
This cost-effectiveness analysis indicates that ET is comparable to MT for treating chronic otitis media in Taiwan. This result provides the latest information for physicians, the government, and third-party payers to select proper clinical practice.
医疗保健系统和医生需要遵循预算并简化资源，以提供具有成本效益的优质护理。尽管内镜鼓室成形术（ET）已经开展了几十年，但尚未发表关于 ET 和显微镜鼓室成形术（MT）治疗慢性中耳炎的成本效益的研究。本研究旨在比较 ET 和 MT 治疗慢性中耳炎的成本效益。
本研究采用队列式 Markov 决策树经济模型，时间范围为 30 年。经济观点为第三方付款人（台湾全民健康保险制度）。比较了两种治疗策略，即 ET 和 MT。主要结果是每个质量调整生命年（QALY）的增量成本。概率来自荟萃分析。成本来自已发表的文献和台湾全民健康保险系统数据库。进行了多次敏感性分析，以考虑数据不确定性。
参考案例表明，ET 的总成本为每位患者 20,901 新台币，可获得 17.08 个 QALY。相比之下，MT 的总成本为每位患者 21,171 新台币，可获得 17.15 个 QALY。ET 与 MT 的增量成本效益比为每 QALY 3703 新台币。成本效益可接受性曲线表明，ET 在支付意愿阈值大于新台币 35,000 元/每 QALY 时，与 MT 相当。
这项成本效益分析表明，ET 在治疗台湾慢性中耳炎方面与 MT 相当。该结果为医生、政府和第三方付款人选择适当的临床实践提供了最新信息。
