Changes in quality of life and the cost-utility associated with cochlear implantation in patients with large vestibular aqueduct syndrome
Changes in quality of life and the cost-utility associated with cochlear implantation in patients with large vestibular aqueduct syndrome
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DOI：
10.1097/00129492-200205000-00016
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发表时间：
2002-05-01
影响因子：
2.1
通讯作者：
Miyamoto, RT
中科院分区：
文献类型：
--
作者：
Bichey, BG;Hoversland, JM;Miyamoto, RT
目的：印第安纳大学医学院发现了一组 20 名患有大前庭导水管综合征的患者。本研究的主要目的是探讨人工耳蜗植入对大前庭导水管综合征患者生活质量的改善，以及该组人工耳蜗植入的成本效益。背景：该医疗中心过去 6 年通过颞骨薄层计算机断层扫描分析，总共 70 名患者被诊断为大前庭导水管综合征。从每位患者的医疗记录中收集的数据包括人口统计数据、听力相关统计数据、植入数据和听力数据。在本研究开始之前，16 名患有大前庭导水管综合征的儿童和成人接受了人工耳蜗植入，其余 54 名儿童和成人被确定为正在接受进行性或波动性感音神经性听力损失的治疗。本分析中使用的健康效用指数是通过安大略省健康效用指数 Mark III 得出的。用于成本效用分析的成本范围来源于该医疗中心的人工耳蜗植入成本，以及医学文献中发表的与植入相关的成本。 方法：参与者选自该中心患有大前庭导水管综合征的舌后聋患者和目前患有严重听力损失的患者总人口。分成了两组。这些组包括患有大前庭导水管综合征的人工耳蜗植入患者或目前使用助听器的大前庭导水管综合征患者。 16 名人工耳蜗植入患者中的 10 名以及其余 54 名患有大前庭导水管综合征的患者中的 10 名符合这些标准。将Mark III健康效用指数分配给各组患者并进行评分。患者未完成的健康效用指数由该中心最熟悉患者的听力学家代理评分。通过比较两组的健康效用指数结果得出与人工耳蜗植入相关的生活质量的变化。然后使用每生活质量年 (QALY) 的贴现成本 (5%) 进行成本效用衡量，并进行敏感性分析来评估代理评分的变化。然后将成本效用结果与类似研究得出的并与其他疾病状态相关的成本效用进行比较。结果：虽然两组患者都有明显的听力损失，但助听器组的平均纯音平均值更好。助听器组的平均纯音平均值为 70.8 dI3 (SD 24.4)，人工耳蜗组的平均纯音平均值为 107.0 dB (SD 21.7)。 20 个健康效用指数中有 7 个是通过代理评分的。基本案例的结果表明，人工耳蜗植入的健康效用提高了 0.20（助听器 = 0.62，人工耳蜗 = 0.82，p = 0.037），导致每个 QALY 的折扣成本为 12,774 美元。代理评分的敏感性分析表明，将健康效用指数的听力分数降低一级会导致人工耳蜗植入的健康效用增加 0.15，从而使每个 QALY 的折扣成本为 17,832 美元。健康效用调查中听力分数下降两个级别导致人工耳蜗植入的生活质量没有显着提高。结论：这项研究发现，患有大前庭导水管综合征的舌后聋患者的生活质量与人工耳蜗植入相关。通过权衡生活质量的改善与每组纯音平均值之间的显着差异，可以进一步证明这一结论。这种生活质量的提高以及人工耳蜗植入成本效益的结果与之前发表的所有类型患者的人工耳蜗植入研究相似。与其他疾病状态的已发表数据相比，这些结果还表明具有良好的成本效益。随着大前庭导水管综合征患者发展至严重程度的听力损失，这些结果表明人工耳蜗植入可以作为一种有益的、改善生活的治疗方法。
Objective: A group of 20 patients with large vestibular aqueduct syndrome was identified at the Indiana University School of Medicine. The major objective of this study was to explore the improvements in quality of life associated with cochlear implantation in patients with large vestibular aqueduct syndrome, as well as the cost-utility of cochlear implantation in this group.Setting: A total of 70 patients were identified with large vestibular aqueduct syndrome through analysis of thin-section computed tomography of the temporal bone over the past 6 years at this medical center. Data collected from the medical records for each patient included demographic data, hearing-related statistics, implantation data, and audiometric data. Sixteen children and adults with large vestibular aqueduct syndrome had undergone cochlear implantation before the beginning of this study, and the remaining 54 children and adults were identified as undergoing treatment of progressive or fluctuant sensorineural hearing loss. Health utility indexes used in this analysis were taken through the use of the Ontario Health Utility Index, Mark III. The range of costs used for cost-utility analysis was derived from the costs of cochlear implantation at this medical center, as well as from costs associated with implantation published in the medical literature.Methods: Participants were selected from the total population of patients with large vestibular aqueduct syndrome at this center who were postlingually deafened and who currently had severe hearing loss. Two groups were formed. These groups comprised either cochlear implant patients with large vestibular aqueduct syndrome or patients with large vestibular aqueduct syndrome currently using hearing aids. Ten of the 16 cochlear implant patients and 10 of the remaining 54 patients with large vestibular aqueduct syndrome met these criteria. Mark III health utility indexes were distributed to patients in each group and scored. Those health utility indexes not completed by the patients were scored by proxy, using the audiologist at this center who was the most familiar with the patient. Changes in quality of life associated with cochlear implantation were derived by comparison of the health utility index results of the two groups. Cost-utility measures were then made using discounted costs per quality-of-life years (QALYs) (5%), and a sensitivity analysis was performed that evaluated changes in scoring done by proxy. The cost-utility results were then compared with the cost-utilities derived from similar studies and associated with other disease states.Results: Although both groups of patients had significant hearing loss, the hearing aid group had a better mean pure-tone average. The mean pure-tone average for the hearing aid group was 70.8 dI3 (SD 24.4), and the mean pure-tone average for the cochlear implant group was 107.0 dB (SD 21.7). Seven of the 20 health utility indexes were scored by proxy. Results from the base case indicate a 0.20 gain in health utility from cochlear implantation (hearing aid = 0.62, cochlear implant = 0.82, p = 0.037), resulting in a discounted cost per QALY of $12,774. Sensitivity analysis of the proxy scoring indicated that decreasing the hearing score one level on the health utility index resulted in a gain in health utility with cochlear implantation of 0.15, resulting in a discounted cost per QALY of $17,832. A decrease of the hearing score by two levels on the health utility survey resulted in no significant gain in quality of life with cochlear implantation.Conclusion: This study found an improvement in quality of life associated with cochlear implantation in postlingually deafened patients with large vestibular aqueduct syndrome. By weighing this improvement in quality of life against the significant difference noted between the pure-tone averages of each group, further strength can be given to this conclusion. This gain in quality of life, as well as the results derived for the cost-utility of cochlear implantation, was similar to that in previous published studies of cochlear implantation in all types of patients. These results also indicate a favorable cost-utility when compared with published data about other disease states. As patients with large vestibular aqueduct syndrome progress to profound levels of hearing loss, these results indicate that cochlear implantation can be offered as a beneficial, life-improving therapy.