Gumbie Mutsa, Olin Emma, Parkinson Bonny, Bowman Ross, Cutler Henry
Macquarie University Centre for the Health Economy, Level 1, 3 Innovation Rd, Sydney, NSW, 2109, Australia.
BMC Health Serv Res. 2021 Apr 8;21(1):319. doi: 10.1186/s12913-021-06271-0.
Research has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults. However, only 13% of eligible Swedish adults currently use a unilateral CI. The objective was to estimate the cost-effectiveness of unilateral CIs compared to a hearing aid for Swedish adults with severe to profound hearing loss.
A Markov model with a lifetime horizon and six-month cycle length was developed to estimate the benefits and costs of unilateral CIs from the Swedish health system perspective. A treatment pathway was developed through consultation with clinical experts to estimate resource use and costs. Unit costs were derived from the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions. Health outcomes were reported in terms of Quality Adjusted Life Years (QALYs).
Unilateral CIs for Swedish adults with severe to profound hearing loss are likely to be deemed cost-effective when compared to a hearing aid (SEK 140,474 per QALY gained). The results were most sensitive to the age when patients are implanted with a CI and the proportion of patients eligible for CIs after triage.
An increase in the prevalence of Swedish adults with severe to profound hearing loss is expected as the population ages. Earlier implantation of unilateral CIs improves the cost-effectiveness among people eligible for CIs. Unilateral CIs are an efficacious and cost-effective option to improve hearing and quality of life in Swedish adults with severe to profound hearing loss.
研究表明，单侧人工耳蜗植入（CI）可显著改善成人的临床疗效和生活质量。然而，目前在符合条件的瑞典成年人中，只有13%使用单侧人工耳蜗。目的是评估与助听器相比，单侧人工耳蜗对瑞典重度至极重度听力损失成年人的成本效益。
建立了一个具有终身时间范围和六个月周期长度的马尔可夫模型，从瑞典卫生系统的角度估计单侧人工耳蜗的益处和成本。通过与临床专家协商制定了治疗路径，以估计资源使用和成本。单位成本来自瑞典国家卫生和福利委员会以及瑞典地方当局和地区协会。健康结果以质量调整生命年（QALY）报告。
与助听器相比，瑞典重度至极重度听力损失的成年人使用单侧人工耳蜗可能被认为具有成本效益（每获得一个QALY为140,474瑞典克朗）。结果对患者接受人工耳蜗植入的年龄以及分诊后符合人工耳蜗植入条件的患者比例最为敏感。
随着人口老龄化，预计瑞典重度至极重度听力损失的成年人患病率会增加。尽早植入单侧人工耳蜗可提高符合人工耳蜗植入条件人群的成本效益。单侧人工耳蜗是改善瑞典重度至极重度听力损失成年人听力和生活质量的一种有效且具有成本效益的选择。
