Macquarie University Centre for the Health Economy, Sydney, Australia.
Health Technology Analysts, Sydney, Australia.
Eur J Health Econ. 2022 Jul;23(5):763-779. doi: 10.1007/s10198-021-01393-y. Epub 2021 Nov 2.
The National Institute for Health and Care Excellence (NICE) updated its eligibility criteria for unilateral cochlear implants (UCIs) in 2019. NICE claimed this would not impact the cost-effectiveness results used within its 2009 technology appraisal guidance. This claim is uncertain given changed clinical practice and increased healthcare unit costs. Our objective was to estimate the cost-effectiveness estimates of UCIs in UK adults with severe to profound hearing loss within the contemporary NHS environment.
A cost-utility analysis employing a Markov model was undertaken to compare UCIs with hearing aids or no hearing aids for people with severe to profound hearing loss. A clinical pathway was developed to estimate resource use. Health-related quality of life, potential adverse events, device upgrades and device failure were captured. Unit costs were derived mostly from the NHS data. Probabilistic sensitivity analysis further assessed the effect of uncertain model inputs.
A UCI is likely to be deemed cost-effective when compared to a hearing aid (£11,946/QALY) or no hearing aid (£10,499/QALY). A UCI has an 93.0% and 98.7% likelihood of being cost-effective within the UK adult population when compared to a hearing aid or no hearing aid, respectively. ICERs were mostly sensitive to the proportion of people eligible for cochlear implant, discount rate, surgery and device costs and processor upgrade cost.
UCIs remain cost-effective despite changes to clinical practice and increased healthcare unit costs. Updating the NICE criteria to provide better access UCIs is projected to increase annual implants in adults and children by 70% and expenditure by £28.6 million within three years. This increased access to UCIs will further improve quality of life of recipients and overall social welfare.
国家卫生与保健卓越研究所（NICE）于 2019 年更新了单侧人工耳蜗植入（UCI）的资格标准。NICE 声称，这不会影响其 2009 年技术评估指南中使用的成本效益结果。鉴于临床实践的变化和医疗保健单位成本的增加，这一说法并不确定。我们的目的是在当代国民保健制度环境下，估计英国严重至极重度听力损失成年人接受 UCI 的成本效益。
采用马尔可夫模型进行成本效用分析，比较严重至极重度听力损失患者使用 UCI 与使用助听器或不使用助听器的情况。制定了一条临床途径来估计资源的使用情况。捕获了与健康相关的生活质量、潜在不良事件、设备升级和设备故障。单位成本主要来自 NHS 数据。概率敏感性分析进一步评估了模型输入不确定的影响。
与助听器（£11946/QALY）或不使用助听器（£10499/QALY）相比，UCI 更有可能被认为是具有成本效益的。当与助听器或不使用助听器相比，UCI 在英国成年人群中分别有 93.0%和 98.7%的可能性具有成本效益。ICER 主要对有资格接受耳蜗植入的人数比例、贴现率、手术和设备成本以及处理器升级成本敏感。
尽管临床实践发生了变化，医疗保健单位成本增加，但 UCI 仍然具有成本效益。更新 NICE 标准以提供更好的 UCI 准入机会，预计将在三年内使成年人和儿童的年度植入量增加 70%，支出增加 2860 万英镑。这种对 UCI 的更多使用将进一步提高接受者的生活质量和整体社会效益。
