Cost-effectiveness of hearing aids in the hearing-impaired elderly: A probabilistic approach
Cost-effectiveness of hearing aids in the hearing-impaired elderly: A probabilistic approach
复制标题
DOI：
10.1097/mao.0b013e31817e5d1b
复制
发表时间：
2008-09-01
影响因子：
2.1
通讯作者：
Chen, Tony Hsiu-Hsi
中科院分区：
文献类型：
--
作者：
Chao, Ting-Kuang;Chen, Tony Hsiu-Hsi
目的：助听器是听力损失康复的主要工具，是老年人中最普遍的损伤之一，但助听器使用的成本效用评级是limited.Design：成本效益analysis.Setting和患者：一个多状态马尔可夫模型被构建到模型50- 80岁的患者之间的状态，包括正常听力，轻度，中度或重度听力损失。在模型中分配的参数部分来自Medline来源（1966-2005），部分来自台湾三级保健中心的听力受损老人（n = 96）的数据。为了解决不确定性，大多数参数都是由分布而不是基本情况值指定的。一个概率的方法与蒙特卡罗模拟进行生产的可接受性曲线，显示的概率是具有成本效益的阈值的意愿（WTP）。主要结果测量：听力相关的质量调整寿命年和成本美元和欧元。结果如下：女性和男性获得额外听力相关质量调整生命年的增量成本分别为US S 135615（（原文如此）10，826）和9，702（原文如此）7，715。如果支付意愿为12，000美元（原文如此），则具有成本效益的概率在妇女中增加到53%，在男子中增加到65%。达到高原的成本效益的概率是67%的女性和78%的男性给予20，000美元的WTP（原文如此）15，904）。结论：通过模拟不同程度的听力损失与多状态模型，助听器的使用被证明是一个具有成本效益的策略，以康复听力受损的老年人。这些结果可以帮助决策者合理有效地分配卫生资源。
Objective: Hearing aids are the principal tool for rehabilitation of hearing loss, one of the most prevalent impairments among elderly adults, but cost-utility ratings for hearing aid use are limited.Design: Cost-effectiveness analysis.Setting and Patients: A multistate Markov model was constructed to model 50- to 80-year-old patients moving between states, including normal hearing, mild, moderate, or severe hearing loss. Parameters assigned in the model are partly derived from the Medline source (1966-2005) and partly from data on hearing-impaired elders (n = 96) in a tertiary care center in Taiwan. To address uncertainty, most of the parameters were specified by distributions, rather than base-case values. A probabilistic approach with Monte Carlo simulations was performed to produce an acceptability curve, showing the probabilities of being cost-effective given threshold values of willingness (WTP).Main Outcome Measures: Hearing-related quality-adjusted life-years and cost in US dollars and Euros. Results: The incremental costs for gaining an additional hearing-related quality-adjusted life-years in women and men were US S 135615 ((sic) 10,826) and 9,702 ((sic) 7,715), respectively. The probability of being cost-effective increased to 53% in women and 65% in men given a WTP of US $12,000 ((sic)9,542). The probabilities of being cost-effective to reach plateau were 67% for women and 78% for men given a WTP of US $20,000 ((sic) 15,904).Conclusion: By modeling different degrees of hearing loss with a multistate model, hearing aid use was demonstrated to be a cost-effective strategy to rehabilitate the hearing-impaired elderly. These results can assist policy makers in allocating health resources appropriately and effectively.