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Cost-Effectiveness of Specialized Treatment Based on Cognitive Behavioral Therapy Versus Usual Care for Tinnitus

Maes, Iris H. L.*†‡; Cima, Rilana F. F.†‡; Anteunis, Lucien J. C.§∥; Scheijen, Dyon J. W. M.; Baguley, David M.; El Refaie, Amr#; Vlaeyen, Johannes W.**‡; Joore, Manuela A.*††

doi: 10.1097/MAO.0000000000000331
Sensorineural Hearing Loss & Tinnitus

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.

*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

Address correspondence and reprint requests to Iris H. L. Maes, M.Sc., Clinical and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; E-mail: iris.nowak.maes@mumc.nl

Funding: Netherlands Organisation for Health Research and Development (ZonMW) grant number 945-07-715

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