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The Impact of Surgical Expertise on the Cost-Effectiveness of Stapes Surgery.
Cohen-Vaizer, Mauricio; Dreyfuss, Michael; Na'ara, Shoorok; Shinnawi, Shadi; Laske, Roman.
Afiliação
  • Cohen-Vaizer M; Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
  • Dreyfuss M; Department of Industrial Engineering and Management, Jerusalem College of Technology, Jerusalem, Israel.
  • Na'ara S; Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
  • Shinnawi S; Department of Otolaryngology, Head and Neck Surgery, University of California at San Francisco, San Francisco, California, USA.
  • Laske R; Department of Otolaryngology Head and Neck Surgery, Rambam Healthcare Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
Audiol Neurootol ; 28(6): 436-445, 2023.
Article em En | MEDLINE | ID: mdl-37343529
INTRODUCTION: Otosclerosis is the primary cause of conductive hearing loss with normal otoscopy. As the condition worsens, certain patients may develop a sensorineural component. Patients with successful surgeries may still need hearing aids, which creates a dilemma for health professionals as there are insufficient data to make informed decisions. This study investigated the influence of the surgeon's proficiency level, individual patient factors (e.g., age at the time of intervention and survival rates), and surgery costs on the cost-effectiveness of stapes surgery. METHODS: We performed a cost-effectiveness analysis using an adapted Markov model incorporating annual all-cause mortalities. In addition, we introduced sensitivity analyses to address the effects of surgical expertise on adults with bilateral conductive hearing loss due to otosclerosis. A model was developed based on a decision tree with treatment options and complication scenarios for otosclerosis patients undergoing stapes surgery or receiving hearing aids. Annual all-cause mortality was considered. A sensitivity analysis was performed assigned to different training levels ("experts" and "less experienced") to simulate the effects of surgical experience on the cost-effectiveness of surgical outcomes. Successful surgery was defined as closing of the air-bone gap to 10 dB or less. Based on published data, "experts" were simulated with a 93.7% success rate, and "less experienced" were manufactured with a 68.9% success rate. RESULTS: Stapes surgery provides improved quality of life (QoL) compared to hearing aids with lower cumulative costs up to 87 years of age in the case of "expert" surgeons and up to 78 years of age, when performed by "less experienced" surgeons. CONCLUSIONS: Primary stapes surgery is highly cost-effective and delivers improved QoL compared to hearing aids with lower cumulative costs. Additionally, undergoing stapes surgical training remains highly cost-effective.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Otosclerose / Cirurgia do Estribo Tipo de estudo: Health_economic_evaluation / Prognostic_studies Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Otosclerose / Cirurgia do Estribo Tipo de estudo: Health_economic_evaluation / Prognostic_studies Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article