Cost-effectiveness of Stapedectomy vs Hearing Aids in the Treatment of Otosclerosis

Gillard, Danielle M.; Harris, Jeffrey P.

doi:10.1001/jamaoto.2019.3221

Cited by 26 publications

(32 citation statements)

References 19 publications

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“…In terms of mean costs per patient over 10 years, surgery was found to be roughly €2641.5 (US $2999.0) less expensive than hearing aids, which is in disagreement with the recent costeffectiveness study by Gillard et al, 11 which found that the lifetime incremental cost of surgery was US $2978.01 higher, although surgery was still found to be cost-effective. 11 This difference can be explained by the fact that surgery is actually 2.5 times more expensive in the United States than in France ($5394), whereas the cost of hearing aids ($2350) is similar. Furthermore, the substantial variation among devices 41 namely the probability of revision surgery (up to 10% per patient per year), the probability of postoperative hearing aid use (up to 12% per patient per year), surgery fees (increased 60%), or the proportion of patients choosing class I devices (up to 94%).…”

Section: Discussioncontrasting

confidence: 62%

“…In a recent US study comparing the cost-effectiveness of surgery and hearing aids for otosclerosis, 11 the incremental cost-effectiveness ratio of stapedectomy was found to be $3918.43 per quality-adjusted life year (QALY). Based on the commonly used threshold of $50 000 per QALY, surgery was therefore deemed to be cost-effective compared with hearing aid use.…”

Section: Introductionmentioning

confidence: 99%

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Estimated Costs Associated With Management of Otosclerosis With Hearing Aids vs Surgery in Europe

et al. 2022

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IMPORTANCE Surgery and hearing aids have similar outcomes in terms of hearing acuity but differ in terms of cost, aesthetics, and patient quality of life. The cost-effectiveness and budget impact of otosclerosis treatments have never been studied in Europe.OBJECTIVES To compare the estimated mean costs per patient over 10 years of surgery vs hearing aids for the treatment of otosclerosis and to estimate the budget impact of an increase in the proportion of patients receiving surgical treatment. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation analyzed French and Europeanepidemiological data on the surgical management of symptomatic otosclerosis and compared them with data from the literature to build economic models. The analysis was conducted in January 2021.EXPOSURES Two care pathways were considered in the treatment of otosclerosis, either hearing aid or surgery. MAIN OUTCOMES AND MEASURESCosts were studied over 10 years using Markov models of the 2 care pathways (hearing aid vs surgery). The budget impact analysis was performed over 5 and 10 years, assuming a 1-percentage point yearly increase in the proportion of patients receiving surgical treatment. RESULTSOver 10 years, the estimated mean cost per patient was significantly lower in the surgery group compared with the hearing aid group (€3446.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Estimated Costs Associated With Management of Otosclerosis With Hearing Aids vs Surgery in Europe

et al. 2022

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“…A serviceable hearing was not preserved in all patients: in 29% of cases, hearing aids were necessary. Other articles confirm a variable rate of hearing aid prescription (20-54%) [Faye-Lund et al, 1984;Lars Lundman et al, 1999;Gillard and Harris, 2020]. Majority of the recent studies suggest that better results can be achieved through the use of lasers, especially by "one-shot" CO 2 laser stapedotomy [Sergi et al, 2016].…”

Section: Discussionmentioning

confidence: 93%

How Long Is Otosclerosis Surgery Effective? Hearing Results after a 22-Year Follow-Up

et al. 2020

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Introduction: Stapes surgery is a safe procedure, with favourable hearing outcome. The objective of the study is to assess the long-term hearing results, addressing the bone conduction (BC) decay and the need for hearing aids in otosclerosis patients. Methods: We enrolled patients who underwent stapes surgery by means of stapedectomy or stapedotomy between 1991 and 2001. All enrolled patients underwent pure-tone audiometry (PTA) between September 2017 and June 2018. A set of questions was administered to record the prevalence of subjective symptoms and the need for hearing aids. Results: Seventy patients were enrolled for a long-term evaluation; 37 patients underwent bilateral surgery; therefore, 107 ears were included in the analysis. The average follow-up period was 22 years. No statistically significant difference was found between early and late post-operative air conduction (AC) PTA (41 vs. 49 dB; p > 0.05) nor between early and late post-operative BC-PTA (29 vs. 37 dB; p > 0.05). A significant difference was observed for AC at 8 kHz (65 vs. 78 dB; p < 0.05) and BC at 2 and 4 kHz (28 vs. 40 dB and 45 vs. 58 dB, respectively; p < 0.05). Conclusions: This is, to our knowledge, the longest mean follow-up time in the literature. A mild decrease in both AC and BC threshold can be expected and the sensorineural decay is more pronounced on the high frequencies. The subjective hearing symptoms and overall sound perception are satisfactory.

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“…Stapes surgery is a successful and widely adopted treatment strategy for otosclerosis [ 30 ]. While stapedotomy is the most used technique, many aspects remain to discuss, and individual preferences prevail on universal consensus.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different oval window sealing materials in stapes surgery: systematic review and meta-analysis

Scarpa

Marra

Ralli

et al. 2022

Eur Arch Otorhinolaryngol

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Objective To compare the efficacy and safety characteristics of different materials used for oval window sealing during stapedotomy. Methods A systematic review was conducted according to the PRISMA guidelines. Published international English literature from January 1, 2000 to December 2021 was screened, checking for studies that compared different materials utilization in patients undergoing stapedotomy surgery for otosclerosis or congenital stapes fixation. Data related to the efficacy and safety of each material were extracted. The primary outcome measure was the air–bone gap (ABG) closure after surgical intervention. Results Six studies were included in the metanalysis. Because of the heterogeneity of the treatments adopted, we assessed the use of the fat compared to all other treatments, and the use of the gelfoam compared to all other treatments. In the former analysis (fat vs others) we did not identify differences in ABG closure between the groups (p = 0.74), with a low heterogeneity of the results (I2 = 28.36%; Hedge’s g = 0.04, 95% CI − 0.19 0.27); similarly, we did not identify differences between the use of gelfoam and other treatments (p = 0.97), with a low heterogeneity of the results (I2 = 28.91%; Hedge’s g = 0.00, 95% CI − 0.20 0.21). Conclusions Numerous options are available for oval window sealing during stapedotomy, with acceptable safety and effectiveness profiles. Based on the current data, no definitive recommendation can be made regarding the choice of one material over another, and the convenience of sealing over no sealing at all.

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Cost-effectiveness of Stapedectomy vs Hearing Aids in the Treatment of Otosclerosis

Cited by 26 publications

References 19 publications

Estimated Costs Associated With Management of Otosclerosis With Hearing Aids vs Surgery in Europe

Estimated Costs Associated With Management of Otosclerosis With Hearing Aids vs Surgery in Europe

How Long Is Otosclerosis Surgery Effective? Hearing Results after a 22-Year Follow-Up

Comparison of different oval window sealing materials in stapes surgery: systematic review and meta-analysis

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