TY - JOUR
T1 - A Multinational Cost-Consequence Analysis of a Bone Conduction Hearing Implant System-A Randomized Trial of a Conventional vs. a Less Invasive Treatment With New Abutment Technology
AU - van Hoof, Marc
AU - Wigren, Stina
AU - Blechert, Johan Ivarsson
AU - Molin, Mattias
AU - Andersson, Henrik
AU - Mateijsen, D. J. M.
AU - Bom, Steven J. H.
AU - Calmels, M. N.
AU - van der Rijt, Antoon J. M.
AU - Flyn, Mark C.
AU - van Tongeren, Joost
AU - Hof, Janny R.
AU - Brunings, Jan Wouter
AU - Anteunis, Lucien J. C.
AU - Algarra, Jaime Marco
AU - Stokroos, Robert Jan
AU - Joore, Manuela A.
PY - 2020/3/13
Y1 - 2020/3/13
N2 - Background: It is hypothesized that, for patients with hearing loss, surgically placing an implant/abutment combination whilst leaving the subcutaneous tissues intact will improve cosmetic and clinical results, increase quality of life (QoL) for the patient, and reduce medical costs. Here, incremental costs and consequences associated with soft tissue preservation surgery with a hydroxyapatite (HA)-coated abutment (test) were compared with the conventional approach, soft tissue reduction surgery with an all-titanium abutment (control).Methods: A cost-consequence analysis was performed based on data gathered over a period of 3 years in an open randomized (1:1) controlled trial (RCT) running in four (sic)pean countries (The Netherlands, Spain, France, and Sweden). Subjects with conductive or mixed hearing loss or single-sided sensorineural deafness were included.Results: During the first year, in the Netherlands (NL), France (FR), and Spain (ES) a net cost saving was achieved in favor of the test intervention because of a lower cost associated with surgery time and adverse event treatments [NL (sic)86 (CI -50.33; 219.20), FR (sic)134 (CI -3.63; 261.30), ES (sic)178 (CI 34.12; 97.48)]. In Sweden (SE), the HA-coated abutment was more expensive than the conventional abutment, which neutralized the cost savings and led to a negative cost (SE (sic)-29 CI -160.27; 97.48) of the new treatment modality. After 3 years, the mean cost saving reduced to (sic)17 (CI -191.80; 213.30) in the Netherlands, in Spain to (sic)84.50 (CI -117.90; 289.50), and in France to (sic)80 (CI -99.40; 248.50). The mean additional cost in Sweden increased to (sic)-116 (CI -326.90; 68.10). The consequences in terms of the subjective audiological benefit and Health-related quality of life (HRQoL) were comparable between treatments. A trend was identified for favorable results in the test group for some consequences and statistical significance is achieved for the cosmetic outcome as assessed by the clinician.Conclusions: From this multinational cost-consequence analysis it can be discerned that health care systems can achieve a cost saving during the first year that regresses after 3 years, by implementing soft tissue preservation surgery with a HA-coated abutment in comparison to the conventional treatment. The cosmetic results are better.
AB - Background: It is hypothesized that, for patients with hearing loss, surgically placing an implant/abutment combination whilst leaving the subcutaneous tissues intact will improve cosmetic and clinical results, increase quality of life (QoL) for the patient, and reduce medical costs. Here, incremental costs and consequences associated with soft tissue preservation surgery with a hydroxyapatite (HA)-coated abutment (test) were compared with the conventional approach, soft tissue reduction surgery with an all-titanium abutment (control).Methods: A cost-consequence analysis was performed based on data gathered over a period of 3 years in an open randomized (1:1) controlled trial (RCT) running in four (sic)pean countries (The Netherlands, Spain, France, and Sweden). Subjects with conductive or mixed hearing loss or single-sided sensorineural deafness were included.Results: During the first year, in the Netherlands (NL), France (FR), and Spain (ES) a net cost saving was achieved in favor of the test intervention because of a lower cost associated with surgery time and adverse event treatments [NL (sic)86 (CI -50.33; 219.20), FR (sic)134 (CI -3.63; 261.30), ES (sic)178 (CI 34.12; 97.48)]. In Sweden (SE), the HA-coated abutment was more expensive than the conventional abutment, which neutralized the cost savings and led to a negative cost (SE (sic)-29 CI -160.27; 97.48) of the new treatment modality. After 3 years, the mean cost saving reduced to (sic)17 (CI -191.80; 213.30) in the Netherlands, in Spain to (sic)84.50 (CI -117.90; 289.50), and in France to (sic)80 (CI -99.40; 248.50). The mean additional cost in Sweden increased to (sic)-116 (CI -326.90; 68.10). The consequences in terms of the subjective audiological benefit and Health-related quality of life (HRQoL) were comparable between treatments. A trend was identified for favorable results in the test group for some consequences and statistical significance is achieved for the cosmetic outcome as assessed by the clinician.Conclusions: From this multinational cost-consequence analysis it can be discerned that health care systems can achieve a cost saving during the first year that regresses after 3 years, by implementing soft tissue preservation surgery with a HA-coated abutment in comparison to the conventional treatment. The cosmetic results are better.
KW - RCT - randomized controlled trial
KW - cost consequence analysis
KW - HTA (health technology assessment)
KW - BAHA
KW - bone conducting device
KW - skin integration
KW - QUALITY-OF-LIFE
KW - OSSEOINTEGRATED IMPLANTS
KW - HEALTH-CARE
KW - AID
KW - PATIENT
KW - BENEFIT
KW - SOUND
KW - COMPLICATIONS
KW - DEAFNESS
KW - SURGERY
U2 - 10.3389/fneur.2020.00106
DO - 10.3389/fneur.2020.00106
M3 - Article
C2 - 32231633
VL - 11
SP - 1
EP - 22
JO - Frontiers in Neurology
JF - Frontiers in Neurology
SN - 1664-2295
M1 - 106
ER -