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Original Investigation
November 7, 2019

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

Author Affiliations
  • 1University of California, San Diego School of Medicine, La Jolla
  • 2Division of Otolaryngology–Head and Neck Surgery, University of California, San Diego, La Jolla
JAMA Otolaryngol Head Neck Surg. Published online November 7, 2019. doi:https://doi.org/10.1001/jamaoto.2019.3221
Key Points

Question  Is stapedectomy a cost-effective method of treating otosclerosis compared with hearing aids?

Findings  This cost-effectiveness analysis found that, although stapedectomy was associated with increased lifetime costs by $2978.01 compared with hearing aids, stapedectomy had an incremental cost-effectiveness ratio of $3918.43 per quality-adjusted life-year.

Meaning  This model suggests that stapedectomy is a cost-effective option for treating otosclerosis from a patient perspective.


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.

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