Economic Evaluation of Percutaneous Titanium Implants for Bone Conduction Hearing: A Cost-benefit Analysis.

Introduction:Developments in bone-anchored hearing implants have resulted in fewer complications, and, thus, lower complication-related costs. However, a weighing of the potential clinical benefits with higher implant purchase price is lacking.Methods:A mathematical Markov model was used to evaluate the total costs (complication costs, implant purchase price, and standard costs) of three widely used current generation implants with expected similar outcomes, compared to a previous generation implant in adult patients over a 10-year time horizon from a healthcare perspective. Parameter estimates were derived from published clinical literature. Missing parameter estimates were based on expert opinion. Implant costs were derived from manufacturer catalogues, while standard and complication costs related to the BAHI were derived from a Dutch University Hospital and Dutch guideline for cost-effectiveness research.Results:The average total costs of the treatment with a previous generation implant was Euro4.967 (SDEuro134) per patient over a 10-year time horizon, compared to Euro4.678 (SD +/- Euro83) with a current generation implant. This implant type is potentially up to Euro506 more beneficial per patient over a 10-year horizon. By further improving implant survival, an additional Euro645 (SD +/- Euro86) per patient could be saved over 10 years.Conclusion:Despite a higher initial purchase price, the current generation implants are potentially cost-beneficial compared with previous generation implants. More data on current generation implants is needed to be able to determine which of the newer implants is most cost-beneficial. Focussing future developments on improving implant survival is likely to have more impact on costs compared with developments on improving soft tissue tolerability.