University of California, San Diego School of Medicine, La Jolla.
Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla.
JAMA Otolaryngol Head Neck Surg. 2020 Jan 1;146(1):42-48. doi: 10.1001/jamaoto.2019.3221.
Otosclerosis can be managed through surgical treatment, such as stapedectomy, or through hearing amplification with hearing aids. To our knowledge, there has been no cost-effectiveness analysis of these 2 treatment methods.
To determine the cost-effectiveness of stapedectomy vs hearing aid use for the treatment of otosclerosis.
In this cost-effectiveness analysis, a decision tree was built to model the treatment choices for otosclerosis. The tree was run as a Markov model of a case patient aged 30 years. The model spanned the patient's lifetime to determine total costs of management of otosclerosis with stapedectomy or hearing aids. Cost-effectiveness was measured using an incremental cost-effectiveness ratio, with a willingness to pay of $50 000 per quality-adjusted life-year (QALY) considered cost-effective. One-way sensitivity analyses were performed for all variables. A 2-way sensitivity analysis was performed for the cost of stapedectomy vs the cost of hearing aids. Probabilistic sensitivity analysis was performed to determine the likelihood that stapedectomy would be cost-effective across a range of model inputs.
Stapedectomy vs hearing aid use.
The primary objective of this study was to determine the cost-effectiveness of stapedectomy vs hearing aids in the treatment of otosclerosis. The secondary objectives were to determine which factors are associated with the cost-effectiveness of the interventions.
Stapedectomy had an estimated lifetime cost of $19 417.95, while hearing aids had an average lifetime cost of $16 439.94. Stapedectomy also had a benefit of 16.58 QALYs, and hearing aids had a benefit of 15.82 QALYs. Stapedectomy increases lifetime costs by $2978.01, with a benefit of 0.76 QALYs compared with hearing aids. The incremental cost-effectiveness ratio for stapedectomy is $3918.43 per QALY. The model was sensitive to the cost of stapedectomy and the cost of stapedectomy revision surgery. Probabilistic sensitivity analysis showed that stapedectomy was cost-effective compared with hearing aids 99.98% of the time.
Stapedectomy appears to be a cost-effective option for treating otosclerosis compared with hearing aid use, from the patient perspective.
重要性：耳硬化症可以通过手术治疗（如镫骨切除术）或通过助听器来进行听力放大。据我们所知，目前还没有对这两种治疗方法进行成本效益分析。
目的：评估镫骨切除术与助听器治疗耳硬化症的成本效益。
设计和环境：在这项成本效益分析中，构建了一个决策树来模拟耳硬化症的治疗选择。该树作为一名 30 岁患者的马尔可夫模型运行。该模型涵盖了患者的整个生命周期，以确定镫骨切除术或助听器治疗耳硬化症的总管理成本。使用增量成本效益比来衡量成本效益，认为每增加一个质量调整生命年（QALY）支付 50000 美元是有成本效益的。对所有变量进行了单向敏感性分析。对镫骨切除术的成本与助听器的成本进行了双向敏感性分析。进行概率敏感性分析以确定在一系列模型输入下镫骨切除术具有成本效益的可能性。
干预措施：镫骨切除术与助听器使用。
主要结果和测量：本研究的主要目的是确定镫骨切除术与助听器治疗耳硬化症的成本效益。次要目标是确定哪些因素与干预措施的成本效益相关。
结果：镫骨切除术的终身估计成本为 19417.95 美元，而助听器的平均终身成本为 16439.94 美元。镫骨切除术还具有 16.58 个 QALY 的获益，而助听器具有 15.82 个 QALY 的获益。与助听器相比，镫骨切除术增加了 2978.01 美元的终生成本，同时增加了 0.76 个 QALY。镫骨切除术的增量成本效益比为每 QALY3918.43 美元。该模型对镫骨切除术的成本和镫骨切除术修正手术的成本敏感。概率敏感性分析表明，镫骨切除术与助听器相比，99.98%的情况下具有成本效益。
结论和相关性：从患者的角度来看，与使用助听器相比，镫骨切除术似乎是治疗耳硬化症的一种具有成本效益的选择。
