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The Cost-effectiveness of Hearing-Aid Fitting in the Netherlands
Manuela A. Joore, PhD;
Hans van der Stel, PhD;
Hans J. M. Peters, PhD;
Gijs M. Boas, PhD;
Lucien J. C. Anteunis, PhD
Arch Otolaryngol Head Neck Surg. 2003;129:297-304.
Objective To determine the cost-effectiveness of hearing-aid fitting.
Design Cost-effectiveness analysis using a Markov model based on aggregate data and results from a prospective intervention study.
Setting The cost-effectiveness study was based in the general community. The prospective study was hospital based, as 85% of the first-time hearing-aid users attend a hospital in the process of hearing-aid fitting.
Patients The prospective intervention study included adult first-time hearing-aid users with no contraindications for hearing-aid use.
Intervention The usual process of hearing-aid fitting in the Netherlands.
Main Outcome Measure Costs per quality-adjusted life-year (QALY). The QALYs were based on EuroQol scores. We included direct and indirect costs in the analysis.
Results The mean improvement on the EuroQol measure was 0.03 (95% confidence interval [CI], -0.03 to 0.08), and on the hearing-specific visual analog scale, 0.27 (95% CI, 0.22-0.31). The base-case outcome based on the EuroQol was €15 807/QALY (US $17 072/QALY) (CI, -€24 239/QALY to €3718/QALY).
Conclusions On the basis of this base-case estimate, fitting of hearing aids is considered a cost-effective health care intervention. The CI indicates that the result is not unambiguously positive, probably because the EuroQol lacked sensitivity for the evaluation of hearing-aid fitting. Until now, no study has found an effect of hearing-aid fitting on generic quality of life. Therefore, measures are needed that are suitable for the evaluation of the effects of interventions for sensory disabilities, such as the fitting of hearing aids, on generic quality of life.
From the Departments of Clinical Epidemiology and Medical Technology Assessment (Dr Joore) and Otorhinolaryngology–Head and Neck Surgery (Dr Anteunis), University Hospital Maastricht, the Department of Quantitative Economics, Faculty of Economics and Business Administration, University of Maastricht (Drs van der Stel and Peters), and the Maastricht Health Economics Research and Consultancy Agency (Dr Boas), Maastricht, the Netherlands.
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