Cost-effectiveness of multidisciplinary management of tinnitus at a specialised tinnitus centre

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1 Cost-effectiveness of multidisciplinary management of tinnitus at a specialised tinnitus centre Maes I, Cima R, Vlaeyen J, Anteunis L, Baguley D, El Refaie A, Scheyen D, Joore M

2 Table of contents Part I Economic evaluation: how does it work? Part II Study design and objective Methods Results Conclusion

3 Economic Evaluation The comparative analysis of alternative courses of action in terms of both their costs and their benefits. Drummond et al., 1996 Economic evaluation is not choosing the cheapest A bridge between the scientific evidence and policy decision making

4 Economic Evaluation Cost A Intervention A Effects A Cost B Intervention B Effects B Difference in costs? Relationship? Difference in effects?

5 Economic Evaluation New intervention Alternative costs effects costs effects Incremental Cost effectiveness ratio (ICER): C n C a E n E a Methods

6 Economic Evaluation Decline Difference in costs? Difference in effects? Accept

7 Economic Evaluation Decline Difference in costs λ = λ = λ = Difference in effects Accept

8 Objective To determine the cost-effectiveness of a specialised integral multidisciplinary tinnitus treatment, compared to care as usual, in an audiological centre in the Netherlands

9 Design Randomized controlled clinical trial: Multi-disciplinary treatment versus care as usual Patients (>18 years) referred to audiological centre in the Netherlands Data collection Baseline Follow-up at 3, 8 and 12 months

10 Methods: effects Generic instruments: Health Utilities Index Mark III Utilities Quality Adjusted Life Years Disease specific questionnaires: Tinnitus Questionnaire

11 Methods: Health Utilities Index mark III 18 questions 8 dimensions with 5 or 6 levels: Vision (6) Dexterity (6) Hearing (6) Emotion (5) Speech (5) Cognition (6) Ambulation (6) Pain / complaints (5) Possible health state: 1, 4, 1, 1, 1, 5, 4, 3

12 Methods: utilities Patient HRQOL Questionnaire Health state (description) Utility (value) Formula reference population

13 Methods: Quality Adjusted Life Years Utility 1 ( )/2 * (3/12) = 0.21 ( )/2 * (5/12) = 0.21 ( )/2 * (4/12) = 0.07 Total QALY = months 8 months 12 months

14 Methods: Costs Societal perspective: Health care costs (CRF; questionnaire) Out of pocket costs (questionnaire) Productivity losses (PRODISQ) Interpolation to yearly cost Costi C ( Ci, t 2 / 3) *5 ( Ci, 3) / i, t1 t 3) * 4

15 Methods: analysis Missing data: Multiple imputation Sensitivity analysis: Complete cases Utilities based on predicted values from mixed multilevel regression analysis

16 Results: effects

17 Results: Effects

18 Results: costs Mean Costs SC UC First level tinnitus care Pure tone audiometry Speech audiometry Tympanometry: incl. stapdial reflexes Tinnitus analysis: PMF, MML Uncomfortable Loudness Levels Individual consult by clinical physicist in audiology Hearing aid fitting New hearing aid Hearing aid check and optimisation Fitting tinnitus masker New tinnitus masker BERA Intake psychologist Tinnitus Educational Group session Second level tinnitus care Individual trajectory Treatment group A Treatment group B Social work trajectory (incl. intake)

19 Results: costs Mean Costs SC UC N First level tinnitus care Second level tinnitus care General practitioner practice Hospital care Other health care professionals Prescribed medication Health care costs Patient & family costs Productivity losses Total societal costs Increment= 122 Increment= 286

20 Results: Cost-effectiveness Cost-effectiveness plane Societal perspective - HUI MI data 3000,00 λ = ,00 Incremental costs 1000,00 0,00-0,10-0,05 0,00 0,05 0,10 0, , , ,00 incremental QALY

21 Results: Cost-effectiveness Cost-effectiveness plane Societal perspective - HUI MI data 3000,00 λ = ,00 Incremental costs 1000,00 0,00-0,10-0,05 0,00 0,05 0,10 0, , , ,00 incremental QALY

22 Results: Cost-effectiveness Cost-effectiveness plane Health care perspective - HUI MI data λ = Incremental costs ,10-0,05 0,00 0,05 0,10 0, incremental QALY

23 Results: Cost-effectiveness Cost-effectiveness plane Health care perspective - HUI MI data λ = Incremental costs ,10-0,05 0,00 0,05 0,10 0, incremental QALY

24 Results: Cost-effectiveness Cost-effectiveness plane Societal perspective - HUI complete cases analysis λ = Incremental costs ,10-0,08-0,06-0,04-0,02 0,00 0,02 0,04 0,06 0,08 0, incremental QALY

25 Results: Cost-effectiveness Cost-effectiveness plane Societal perspective - HUI complete cases analysis λ = Incremental costs ,10-0,08-0,06-0,04-0,02 0,00 0,02 0,04 0,06 0,08 0, incremental QALY

26 Results: Cost-effectiveness Cost-effectiveness plane Health care perspective - HUI complete cases analysis 3000 λ = Incremental costs ,10-0,08-0,06-0,04-0,02 0,00 0,02 0,04 0,06 0,08 0, incremental QALY

27 Results: Cost-effectiveness Cost-effectiveness plane Health care perspective - HUI complete cases analysis λ = Incremental costs ,10-0,08-0,06-0,04-0,02 0,00 0,02 0,04 0,06 0,08 0, incremental QALY

28 Conclusion 1. Increase in utility in SC; decrease in UC 2. QALY UC < QALY SC 3. SC more costly than UC 4. SC is more cost-effective than UC

29 Questions?

Assessment of Health State in Patients With Tinnitus: A Comparison of the EQ-5D and HUI Mark III

Assessment of Health State in Patients With Tinnitus: A Comparison of the EQ-5D and HUI Mark III Iris H. L. Maes, 1,2,3 Manuela A. Joore, 1 Rilana F. F. Cima, 2,3 Johannes W. Vlaeyen, 3,4 and Lucien J.