Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina.
JAMA Otolaryngol Head Neck Surg. 2023 Jul 1;149(7):607-614. doi: 10.1001/jamaoto.2023.0949.
Over-the-counter (OTC) hearing aids are now available in the US; however, their clinical and economic outcomes are unknown.
To project the clinical and economic outcomes of traditional hearing aid provision compared with OTC hearing aid provision.
DESIGN, SETTING, AND PARTICIPANTS: This cost-effectiveness analysis used a previously validated decision model of hearing loss (HL) to simulate US adults aged 40 years and older across their lifetime in US primary care offices who experienced yearly probabilities of acquiring HL (0.1%-10.4%), worsening of their HL, and traditional hearing aid uptake (0.5%-8.1%/y at a fixed uptake cost of $3690) and utility benefits (0.11 additional utils/y). For OTC hearing aid provision, persons with perceived mild to moderate HL experienced increased OTC hearing aid uptake (1%-16%/y) based on estimates of time to first HL diagnosis. In the base case, OTC hearing aid utility benefits ranged from 0.05 to 0.11 additional utils/y (45%-100% of traditional hearing aids), and costs were $200 to $1400 (5%-38% of traditional hearing aids). Distributions were assigned to parameters to conduct probabilistic uncertainty analysis.
Provision of OTC hearing aids, at increased uptake rates, across a range of effectiveness and costs.
Lifetime undiscounted and discounted (3%/y) costs and quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).
Traditional hearing aid provision resulted in 18.162 QALYs, compared with 18.162 to 18.186 for OTC hearing aids varying with OTC hearing aid utility benefit (45%-100% that of traditional hearing aids). Provision of OTC hearing aids was associated with greater lifetime discounted costs by $70 to $200 along with OTC device cost ($200-$1000/pair; 5%-38% traditional hearing aid cost) due to increased hearing aid uptake. Provision of OTC hearing aids was considered cost-effective (ICER<$100 000/QALY) if the OTC utility benefit was 0.06 or greater (55% of the traditional hearing aid effectiveness). In probabilistic uncertainty analysis, OTC hearing aid provision was cost-effective in 53% of simulations.
In this cost-effectiveness analysis, provision of OTC hearing aids was associated with greater uptake of hearing intervention and was cost-effective over a range of prices so long as OTC hearing aids were greater than 55% as beneficial to patient quality of life as traditional hearing aids.
非处方（OTC）助听器现可在美国购买，但它们的临床和经济效果尚不清楚。
预测传统助听器与 OTC 助听器的临床和经济效果。
设计、环境和参与者：本成本效益分析使用了先前验证的听力损失（HL）决策模型，对美国初级保健办公室中每年有 0.1%-10.4%的 HL 发病概率、HL 恶化和传统助听器使用率（0.5%-8.1%/年，固定采用成本为 3690 美元）和效用获益（0.11 个额外单位/年）的 40 岁及以上美国成年人进行了终生模拟。对于 OTC 助听器的提供，根据首次 HL 诊断时间的估计，有轻度至中度 HL 感知的人会增加 OTC 助听器的采用率（1%-16%/年）。在基础情况下，OTC 助听器的效用获益在 0.05 至 0.11 个额外单位/年之间（传统助听器的 45%-100%），而成本为 200 至 1400 美元（传统助听器的 5%-38%）。对参数进行了分配，以进行概率不确定性分析。
在各种有效性和成本范围内，增加 OTC 助听器的采用率。
终生未贴现和贴现（3%/年）成本以及质量调整生命年（QALY）和增量成本效益比（ICER）。
传统助听器的提供导致了 18.162 个 QALY，而 OTC 助听器的提供范围为 18.162 至 18.186，其效用获益因 OTC 助听器而异（传统助听器的 45%-100%）。由于助听器的采用率增加，与 OTC 设备成本（每对 200-1000 美元；传统助听器成本的 5%-38%）一起，提供 OTC 助听器与每年的贴现成本增加 70 至 200 美元相关。由于 OTC 助听器的采用率增加，提供 OTC 助听器被认为具有成本效益（ICER<100000 美元/QALY），如果 OTC 效用获益为 0.06 或更高（传统助听器效果的 55%）。在概率不确定性分析中，53%的模拟情况下，提供 OTC 助听器具有成本效益。
在这项成本效益分析中，提供 OTC 助听器与听力干预的采用率增加有关，只要 OTC 助听器的效果比传统助听器高出 55%，对患者的生活质量有好处，那么在一定价格范围内，它就是具有成本效益的。
