A MARKOV MICROSIMULATION MODEL FOR THE ECONOMIC EVALUATION OF PARTIALLY IMPLANTABLE ACTIVE MIDDLE EAR IMPLANTS IN SENSORINEURAL HEARING LOSS
Author(s)
Kluibenschaedl M, Kosaner Kliess M, Urban M
MED-EL Medical Electronics, Innsbruck, Austria
Presentation Documents
OBJECTIVES: Partially implantable active middle ear implants (aMEIs) offer a solution to treat mild to severe sensorineural hearing loss when patients are unable to wear or benefit from conventional hearing aids. These patients are also unable to benefit from cochlear implants because their hearing loss is not severe enough. If left untreated, individuals report a reduced quality of life compared to normal hearing peers that may further decrease with increasing hearing loss. The implementation of this treatment strategy may have considerable consequences and involve significant uncertainties and trade-offs. Due to lack of long-term data, decision-analytic modeling can be used to inform decisions under conditions of uncertainty. METHODS: To represent uncertainty in patient-level outcomes a Markov model was analyzed as microsimulation. A third-party payer perspective of the Australian health-care setting was adopted and a discount rate of 5% was used for both costs and utilities. The model time frame was set to 10 years. The model cycle length was 6 months. This work contains previously unpublished analyses. RESULTS: Compared with no surgical intervention, aMEIs yielded an incremental cost-utility ratio (ICUR) of AUD 9,913.72/QALY. When changing the discount rate from 5% to 3%, the ICUR was AUD 9,396.51/QALY. To measure the impact of variations on the ICUR, the utility value of patients successfully aided with or without complications were varied by ± 0.03, which yielded an ICUR ranging from AUD 7,474.52/QALY to 14,591.44/QALY. When altering the time horizon from 5 years to lifetime, the ICUR was AUD 8,067.39/QALY and AUD 14,184.68/QALY, respectively. According to literature, the Australian willingness-to-pay (WTP) threshold is reported to be AUD 34,500. When comparing the ICUR against the WTP threshold, aMEI had a probability of 100% to be cost-effective. CONCLUSIONS: Based on these analyses, partially implantable aMEIs offer a cost-effective solution compared with no surgical intervention in the Australian health-care setting.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PRM105
Topic
Methodological & Statistical Research
Topic Subcategory
Modeling and simulation
Disease
Sensory System Disorders