Landry Evie C, Scholte Mirre, Su Matthew P, Horstink Yvette, Mandavia Rishi, Rovers Maroeska M, Schilder Anne G M
Division of Otolaryngology-Head and Neck Surgery, St. Paul's Hospital, BC Rotary Hearing and Balance Centre, University of British Columbia, Vancouver, BC, Canada.
National Institute for Health Research University College London Hospitals Biomedical Research Centre Hearing Theme, London, United Kingdom.
Front Neurosci. 2022 Mar 4;16:769983. doi: 10.3389/fnins.2022.769983. eCollection 2022.
Health systems face challenges to accelerate access to innovations that add value and avoid those unlikely to do so. This is very timely to the field of age-related sensorineural hearing loss (ARHL), where a significant unmet market need has been identified and sizeable investments made to promote the development of novel hearing therapeutics (NT). This study aims to apply health economic modeling to inform the development of cost-effective NT.
We developed a decision-analytic model to assess the potential costs and effects of using regenerative NT in patients ≥50 with ARHL. This was compared to the current standard of care including hearing aids and cochlear implants. Input data was collected from systematic literature searches and expert opinion. A UK NHS healthcare perspective was adopted. Three different but related analyses were performed using probabilistic modeling: (1) headroom analysis, (2) scenario analyses, and (3) threshold analyses.
The headroom analysis shows an incremental net monetary benefit (iNMB) of £20,017[£11,299-£28,737] compared to the standard of care due to quality-adjusted life-years (QALY) gains and cost savings. Higher therapeutic efficacy and access for patients with all degrees of hearing loss yields higher iNMBs. Threshold analyses shows that the ceiling price of the therapeutic increases with more severe degrees of hearing loss.
NT for ARHL are potentially cost-effective under current willingness-to-pay (WTP) thresholds with considerable room for improvement in the current standard of care pathway. Our model can be used to help decision makers decide which therapeutics represent value for money and are worth commissioning, thereby paving the way for urgently needed NT.
卫生系统面临着加快获取具有附加值的创新成果并避免采用那些不太可能有价值的创新成果的挑战。这对于年龄相关性感音神经性听力损失（ARHL）领域来说非常及时，在该领域已确定存在重大未满足的市场需求，并且已进行了大量投资以促进新型听力治疗方法（NT）的开发。本研究旨在应用卫生经济模型为具有成本效益的NT的开发提供信息。
我们开发了一个决策分析模型，以评估在≥50岁的ARHL患者中使用再生NT的潜在成本和效果。将其与包括助听器和人工耳蜗在内的当前护理标准进行比较。输入数据通过系统的文献检索和专家意见收集。采用英国国民健康服务体系（NHS）医疗保健视角。使用概率模型进行了三种不同但相关的分析：（1）净收益空间分析，（2）情景分析，以及（3）阈值分析。
净收益空间分析显示，由于质量调整生命年（QALY）的增加和成本节约，与护理标准相比，增量净货币收益（iNMB）为20,017英镑[11,299英镑 - 28,737英镑]。所有听力损失程度的患者具有更高的治疗效果和可及性会产生更高的iNMB。阈值分析表明，治疗方法的最高价格随着听力损失程度的加重而增加。
在当前的支付意愿（WTP）阈值下，用于ARHL的NT可能具有成本效益，并且当前护理标准途径有相当大的改进空间。我们的模型可用于帮助决策者确定哪些治疗方法具有性价比且值得委托实施，从而为急需的NT铺平道路。
