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Kostnader och effekter vid förskrivning av hörapparat
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
2008 (Swedish)Report (Other academic)
Abstract [sv]

Studiens syfte var att undersöka effektivitet och kostnadseffektivitet för nyförskrivning av hörapparater, inkluderande jämförelse mellan ”enkel” apparat (analog) och ”avancerad” (digital). Studien var randomiserad ”cross-over”- studie, enkelblind genom att apparaternas höljen gjorts likartade och utan beteckningar. Som utfallsmått användes dels ett primärt utfallsmått, ”tal i brus”, dels generiska mått relaterade till problemlösningsförmåga (IPPA, PIRS) och hälsorelaterad livskvalitet (EQ-5D, HUI3). Vidare studerades brukarnas preferenser vad gäller apparat såväl utan som med kännedom om kostnader.    Studien gjordes i samverkan med hörcentraler vid landstingen i Östergötlands, Kalmar och Jönköpings län. Under 2002 och 2003 rekryterades 161 brukare till studien; medelåldern var ca 70 år, 60 procent män och 40 procent kvinnor.

Nyförskrivning av hörapparat, ”bakom örat”-modell bilateralt om ej kontraindikation för detta förelåg, ger för samtliga ovan nämnda utfallsmått en avsevärd förbättring. Förskrivningens kostnadseffektivitet, med fritt val mellan apparattyperna (ungefärligen lika många väljer enkel som avancerad), ger en kostnad per vunnet kvalitetsjusterat levnadsår av 80 000 kronor mätt med EQ-5D och 17 300 kronor mätt med HUI3. Härvid har vi antagit att livskvalitetsförhöjningen står sig över fem år, vidare har kostnader inkluderats för läkarbesök, audiogram, utprovning, tillverkning av två insatser samt apparatkostnader.

I en jämförelse mellan apparattyperna ger den avancerade apparaten signifikant högre andel uppfattade ord i ”tal i brus”-testet samt signifikant bättre problemlösningsförmåga (IPPA), dock endast något svagare förbättring enlig PIRS. Livskvaliteten (EQ-5D) skattades något högre för den enkla apparaten.

När brukaren genomgått testperioder med respektive apparattyp erbjöds han/hon att välja apparat. Utan kännedom om egenavgifterna valde 62 procent den avancerade apparaten. Med kostnadskännedom ändrade sig 11 personer och valde enkel apparat, en valde unilateral anpassning men bibehöll avancerad apparat. Med kostnadskännedom var således fördelningen mellan apparattyperna lika. Betalningsviljan är således för många brukare betydande och kan uppgå till en merkostnad av ca 8000 kronor för att få den avancerade apparaten i stället för den enkla. Utan kostnadskännedom valde 88% dubbelsidig anpassning och 12% hörapparat till enbart ett öra. Med kostnadskännedom ändrades detta till 87% respektive 13%.

Studien har visat att hörapparatförskrivning för förstagångsanvändare har hög kostnadseffektivitet. Avancerad apparat ger signifikant förbättrad taluppfattning jämfört med enkel apparat. Livskvalitetsmätningarna i studien tyder på att det är svårt att utifrån dessa avgöra värdet av specifika olikheter mellan apparattyper.

Abstract [en]

This study aimed at investigating effectiveness and cost-effectiveness of hearing aid fitting. Especially, two types, i.e. linear one-channel AGC (simple) and nonlinear multichannel AGC (advanced), were compared. Randomised cross-over design was used, blinded through similar shells of the devices without any identifications of type. Outcome measures were “speech in noise”, problem solving ability (IPPA, PIRS) and health related quality of life (EQ-5D, HUI3). In addition, the users’ preferences with regard to final choice of hearing aid with and without information on costs were studied.

The study was a collaboration with hearing aid centres in the county councils of Östergötland, Kalmar and Jönköping in the southeast of Sweden. During 2002 and 2003, 161 users were recruited to the study, mean age was 70 years, 60 % were men and 40 % women. The intervention was fitting of hearing aids to first time applicants, bilaterally “behind the ear” model, if no contra-indication for bilateral fitting was present.

Free choice of equipment without any information on costs resulted in prescription of about 60 % of simple and and 40 % of advanced hearing aids. With information on costs the corresponding figures were 50%/50 %. The costeffectiveness, measured as cost per quality adjusted life years gained (cost/QALY) was 80 000 SEK based on EQ-5D and 17 300 SEK based on HUI3 Assumptions were an improvement of quality of life which was sustainable over five years. The costs included visit to physician, audiogram, assessment and construction of two earmolds and investment costs for the devices. Without information about costs 88% choose bilateral fitting and 12% unilateral. With information of costs these figures changed marginally to 87% and 13%, respectively.

The advanced device performed significantly better in the “speech in noise” test (p=0.004) and problem solving ability measured through IPPA (p=0.044). Quality of life showed significantly lower results (p=0.009) of the use of the advanced device.

Only a small fraction, 12 persons, changed their decision on device after cost information, 11 of these changed from advanced to simple device and one from bilateral to unilateral fitting (still advanced). The additional costs between bilateral and unilateral fitting amounted to about 8000 SEK, which seems to be an amount which the main group of users were willing to pay. No adjustment to household incomes was made.

It has been shown that hearing aid fitting for first time applicants has a high (favorable) cost-effectiveness. The advanced device yields an improved speech recognition in noise in comparison with the simple device. The measurements of quality of life indicate difficulties to discriminate between types of devices. It could be that subgroups’ value the two types differently. An hypothesis, which has not been tested, is whether people with better cognitive ability prefer the advanced device to a higher extent than do users with lower cognitive ablity.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 36 p.
Series
CMT Report, ISSN 0283-1228 (print), 1653-7556 (online) ; 2008:5
Keyword [en]
Hearing aids, economics, quality of life
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-44510ISRN: LIU CMT RA/0805Local ID: 76922OAI: oai:DiVA.org:liu-44510DiVA: diva2:265372
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-10-24Bibliographically approved

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Persson, JanArlinger, StigHusberg, Magnus

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