Cost-Effectiveness of Specialized Treatment Based on Cognitive Behavioral Therapy Versus Usual Care for Tinnitus
Cost-Effectiveness of Specialized Treatment Based on Cognitive Behavioral Therapy Versus Usual Care for Tinnitus
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DOI：
10.1097/mao.0000000000000331
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发表时间：
2014-06-01
影响因子：
2.1
通讯作者：
Joore, Manuela A.
中科院分区：
文献类型：
--
作者：
Maes, Iris H. L.;Cima, Rilana F. F.;Joore, Manuela A.
目的：为了评估成本效益的专业多学科耳鸣治疗的基础上认知行为疗法，与护理assum.Design相比：随机对照试验，包括从医疗保健和社会的角度进行经济评估，使用一年的时间horizontal.Setting：听力中心。患者：626例耳鸣患者的参考样本有资格参与。约492名患者被纳入研究。常规护理组247例患者中有86例（35%）和专门护理组245例患者中有74例（30%）在第12个月失访。主要结果测量：用健康效用指数Mark III和美元成本测量的质量调整生命年（Qs）。与接受常规护理的患者相比，接受专业护理的患者平均获得0.015 Qs（95%自举置信区间[BCI]，-0.03至0.06）。从社会角度来看，增量成本为357美元（95%BCI，-1，034美元至1，785美元）。从社会角度看，每个质量调整生命年的增量成本为24，580美元。从社会角度来看，愿意支付45，000美元QALY的SC成本效益的概率为58%。结论：与常规治疗相比，基于认知行为疗法的专业多学科耳鸣治疗具有成本效益。虽然围绕增量成本和影响的不确定性很大，但敏感性分析表明，成本效益结果是可靠的。
Objective: To evaluate the cost-effectiveness of specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy, compared with care as usual.Design: Randomized controlled trial including an economic evaluation from a health-care and societal perspective, using a one-year time horizon.Setting: Audiologic center.Patients: A referred sample of 626 patients with tinnitus were eligible for participation. Approximately 492 patients were included in the study. Eighty-six (35%) of 247 patients in the usual care group, and 74 (30%) of 245 patients in the specialized care group were lost to follow-up by month 12.Main Outcome Measures: Quality adjusted life years (QALYs) as measured with the Health Utilities Index Mark III and cost in US dollars.Results: Compared with patients receiving usual care, patients who received specialized care gained on average 0.015 QALYs (95% bootstrapped confidence interval [BCI], -0.03 to 0.06). The incremental costs from a societal perspective are $357 (95% BCI, -$1,034 to $1,785). The incremental cost per QALY from a societal perspective amounted to $24,580. The probability that SC is cost-effective from a societal perspective is 58% for a willingness to pay for a QALY of $45,000.Conclusion: Specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy is cost-effective as compared with usual care. Although uncertainty surrounding the incremental costs and effects is considerable, sensitivity analysis indicated that cost-effectiveness results were robust.