成人人工耳蜗植入的年龄相关成本效益。是否存在与年龄相关的截止点？

Age Dependent Cost-Effectiveness of Cochlear Implantation in Adults. Is There an Age Related Cut-off?

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich.

University of Zurich, Zurich, Switzerland.

出版信息

Otol Neurotol. 2019 Aug;40(7):892-899. doi: 10.1097/MAO.0000000000002275.

DOI:10.1097/MAO.0000000000002275

PMID:31157721

Abstract

OBJECTIVE

To analyze the impact of age at implantation on the cost-effectiveness of cochlear implantation (CI).

STUDY DESIGN

Cost-utility analysis in an adapted Markov model.

SETTING

Adults with profound postlingual hearing loss in a "high income" country.

INTERVENTION

Unilateral and sequential CI were compared with hearing aids (HA).

MAIN OUTCOME MEASURE

Incremental cost-effectiveness ratio (ICER), calculated as costs per quality adjusted life year (QALY) gained (in CHF/QALY), for individual age and sex combinations in relation to two different willingness to pay thresholds. 1 CHF (Swiss franc) is equivalent to 1.01 USD.

RESULTS

When a threshold of 50,000 CHF per QALY is applied, unilateral CI in comparison to HA is cost-effective up to an age of 91 for women and 89 for men. Sequential CI in comparison to HA is cost-effective up to an age of 87 for women and 85 for men. If a more contemporary threshold of 100,000 CHF per QALY is applied, sequential CI in comparison to unilateral CI is cost-effective up to an age of 80 for women and 78 for men.

CONCLUSIONS

Performing both sequential and unilateral CI is cost-effective up to very advanced ages when compared with hearing aids.

摘要

目的

分析植入年龄对人工耳蜗植入（CI）成本效益的影响。

研究设计

适应性马尔可夫模型中的成本效益分析。

设置

高收入国家中患有后天性重度听力损失的成年人。

干预措施

单侧和序贯 CI 与助听器（HA）进行比较。

主要观察指标

个体年龄和性别组合与两个不同支付意愿阈值相关的增量成本效益比（ICER），以每获得质量调整生命年（QALY）的成本（以瑞士法郎/ QALY 计算）表示。1 瑞士法郎（瑞士法郎）相当于 1.01 美元。

结果

当应用每 QALY 50,000 瑞士法郎的阈值时，与 HA 相比，女性单侧 CI 的成本效益高达 91 岁，男性为 89 岁。与 HA 相比，序贯 CI 的成本效益高达女性 87 岁和男性 85 岁。如果应用更现代的每 QALY 100,000 瑞士法郎的阈值，与单侧 CI 相比，序贯 CI 的成本效益高达女性 80 岁和男性 78 岁。