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Cost-effectiveness of specialized treatment based on cognitive behavioral therapy versus usual care for tinnitus
Iris H L Maes1, Rilana F F Cima, Lucien J C Anteunis
1*Clinical and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht; †Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek; ‡Clinical Psychological Science, Maastricht University; §Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, ∥School for Mental Health and Neuroscience of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ¶Departments of Otolaryngology and Audiology, Addenbrooke's Hospital, Cambridge; #Centre for Hearing and Balance Studies, Bristol University, Bristol, U.K.; **Research Group Health Psychology, University of Leuven, Leuven, Belgium; and ††School for Public Health and Primary Care of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Objective:
To evaluate the cost-effectiveness of specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy, compared with care as usual.
Design:
Randomized controlled trial including an economic evaluation from a health-care and societal perspective, using a one-year time horizon.
Setting:
Audiologic center.
Patients:
A referred sample of 626 patients with tinnitus were eligible for participation. Approximately 492 patients were included in the study. Eighty-six (35%) of 247 patients in the usual care group, and 74 (30%) of 245 patients in the specialized care group were lost to follow-up by month 12.
Main Outcome Measures:
Quality adjusted life years (QALYs) as measured with the Health Utilities Index Mark III and cost in US dollars.
Results:
Compared with patients receiving usual care, patients who received specialized care gained on average 0.015 QALYs (95% bootstrapped confidence interval [BCI], -0.03 to 0.06). The incremental costs from a societal perspective are $357 (95% BCI,-$1,034 to $1,785). The incremental cost per QALY from a societal perspective amounted to $24,580. The probability that SC is cost-effective from a societal perspective is 58% for a willingness to pay for a QALY of $45,000.
Conclusion:
Specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy is cost-effective as compared with usual care. Although uncertainty surrounding the incremental costs and effects is considerable, sensitivity analysis indicated that cost-effectiveness results were robust.
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