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

Importance: Otosclerosis can be managed through surgical treatment, such as stapedectomy, or through hearing amplification with hearing aids. To our knowledge, there has been no cost-effectiveness analysis of these 2 treatment methods. Objective: To determine the cost-effectiveness of stapedectomy vs hearing aid use for the treatment of otosclerosis. Design and Setting: In this cost-effectiveness analysis, a decision tree was built to model the treatment choices for otosclerosis. The tree was run as a Markov model of a case patient aged 30 years. The model spanned the patient's lifetime to determine total costs of management of otosclerosis with stapedectomy or hearing aids. Cost-effectiveness was measured using an incremental cost-effectiveness ratio, with a willingness to pay of $50 000 per quality-adjusted life-year (QALY) considered cost-effective. One-way sensitivity analyses were performed for all variables. A 2-way sensitivity analysis was performed for the cost of stapedectomy vs the cost of hearing aids. Probabilistic sensitivity analysis was performed to determine the likelihood that stapedectomy would be cost-effective across a range of model inputs. Interventions: Stapedectomy vs hearing aid use. Main Outcomes and Measures: The primary objective of this study was to determine the cost-effectiveness of stapedectomy vs hearing aids in the treatment of otosclerosis. The secondary objectives were to determine which factors are associated with the cost-effectiveness of the interventions. Results: Stapedectomy had an estimated lifetime cost of $19 417.95, while hearing aids had an average lifetime cost of $16 439.94. Stapedectomy also had a benefit of 16.58 QALYs, and hearing aids had a benefit of 15.82 QALYs. Stapedectomy increases lifetime costs by $2978.01, with a benefit of 0.76 QALYs compared with hearing aids. The incremental cost-effectiveness ratio for stapedectomy is $3918.43 per QALY. The model was sensitive to the cost of stapedectomy and the cost of stapedectomy revision surgery. Probabilistic sensitivity analysis showed that stapedectomy was cost-effective compared with hearing aids 99.98% of the time. Conclusions and Relevance: Stapedectomy appears to be a cost-effective option for treating otosclerosis compared with hearing aid use, from the patient perspective.

Malpractice in otology.

OBJECTIVE: (1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. STUDY DESIGN AND SETTING: Case series with record review. METHODS: The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. RESULTS: Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively). CONCLUSIONS: Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

Economic viability of stapes surgery in Germany.

OBJECTIVE: The purpose of this study was to determine the economic viability of stapes surgery in Germany. We compared the cost of the operation to the retail value and average cost of a lifelong supply of hearing aids. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral centre. PATIENTS: One hundred and sixty-four consecutive cases of primary stapedotomy performed on patients with otosclerosis at our institution served as the representative group for the calculation. The post-operative air-bone gap average at the frequencies 500, 1000, 2000 and 4000 Hz was less than 10 dB for 62 per cent of the patients, and less than 20 dB for 92 per cent of the patients. There was a post-operative sensorineural hearing loss in 1.2 per cent of the patients. RESULTS: Analysis showed that, even for an elderly patient aged 65 years with a life expectancy of 15 years, the cost of a lifelong supply of hearing aids was greater than that of a stapedotomy procedure. Based on our group of patients, the stapedotomy procedure proved to be euro 800,000 K cheaper than treatment with an averagely priced hearing aid. The economic benefit was still present when taking into account possible revision surgery in 5-10 per cent of cases, and also when, in addition to the surgery, a post-operative hearing aid was required, in for example 20 per cent of cases. CONCLUSION: Stapes surgery is economically beneficial for the individual patient as well as for the general patient cohort, irrespective of age. The stapedotomy procedure also prevents the known disadvantages of conventional hearing aids, thus improving the patient's quality of life.

[Postoperative complications in stapes surgery. An analysis of medical and economic aspects]. / Postoperative Komplikationen der Stapesplastik. Eine Analyse unter medizinisch-ökonomischen Aspekten.

With the establishment of DRGs in the German hospital financing system, knowledge of therapy costs and the suitability of therapies for reservation planning and medical cost management becomes important. Stapes surgery and its postoperative treatment is relatively standardised. The timing of intervention can be planned and serious complications are rare. We carried out a retrospective evaluation of all stapedectomies performed in Bochum University ENT department over 1 year ( n=46). The course of treatment and differences in expenditure between standard and complicated cases were recorded. We used the official calculation model of the Deutsche Krankenhausgesellschaft and the homogeneneity of the investigated patient groups was evaluated statistically. A total of 6.52% of all patients had complications, mainly temporary inner ear hearing deficit and vertigo, resulting in additional therapy. The average cost of a stapedectomy was 964 EUR for regular cases. The costs if complications occurred ranged from 1,754 EUR to 3,504 EUR. Statistical evaluation showed a strong homogeneity in the group of patients without complications, especially for the costs of surgery. Stapedectomy is suitable for flat rates due to the standardisation of therapy and the homogeneity of the patients. The profitability depends on the future DRG-flat-rate. Stapedectomy surgery seems to be appropriate for resource and cost management. To avoid unfair future losses for the hospitals, a mechanism of compensation for very expensive medical complications should be developed.