Dynamic Modeling in Medical Technology Assessment

Abstract

Objectives:The main objective of this article is to demonstrate the usefulness of dynamic modeling for an economic assessment of technology in health care. Specifically, this approach is applied to assess the impact of the use of hearing aids in Dutch health care. Methods: The population is divided into different health classes between which, over time, transitions occur. Transition probabilities are derived from exogenous data. The transitions are associated with economic and societal costs and benefits. People who are satisfied with their hearing aids experience benefits. These benefits are expressed by quality-adjusted life-years (QALYs). Costs are made during transitions (mainly the fitting of hearing aids). A cohort analysis is carried out, starting with people in a particular age group. The starting point is a fixed number of people within this age group, who are followed during their whole lifetime. Results: Costs per QALY ratios are calculated for two health programs. The Fitting Hearing Aid Program describes the present situation in the Netherlands; the Post-purchase Counseling Hearing Aid Program is a hypothetical addition to the first program, where an intervention based on a Dutch study is undertaken to improve satisfaction with hearing aids. Future benefits and costs are discounted at a rate of 5%. Conclusions: The dynamic modeling approach provides a more realistic picture than a static approach. Particularly, the cost-effectiveness of the Fitting Hearing Aid Program is compared with the Post-purchase Counseling Hearing Aid Program.

The Cost-effectiveness of Hearing-Aid Fitting in the Netherlands

“…Future costs and benefits were discounted to their present value by a rate of 5%. Boas et al 9 described the technical and methodological merits of dynamic modeling in the case of hearing-aid fitting more extensively.…”

A Review of Cost-Effectiveness Analysis and Model of Hearing Aid Fitting

“…Changes of hearing aid intervention policy or individual transitions should be considered to reduce a probability of unsatisfactory outcomes with hearing aids. Accordingly, other studies showed cost-effectiveness of follow up counseling (Boas et al, 2001;Vuorialho et al, 2006) and hearing screening (Baltussen & Smith, 2009;Rob et al, 2009). These indicate that providing relevant services in pre and post stages of hearing aid fitting is cost-effective and may play an important role to reduce unsatisfied hearing aid users.…”

“…aN aDOpTeD COsT-effeCTIveNess mODel Of heaRINg aID fITTINg IN sOUTh KORea Joore et al (2003) analyzed cost-effectiveness of hearing aid fitting in the Netherlands based on a dynamic patient flow model (Boas et al, 2001). The model was used to estimate economic costs for hearing aid fitting in Netherland considering transitions occurred over time at various health care divisions including audiological centers and medical centers.…”

Cost-Utility Analysis of Hearing Aid Device for Older Adults in the Community: A Delayed Start Study

“…With earlier screening of hearing loss in the adult population, future studies can investigate productivity gains in greater detail and over a longer period. Future research in Singapore can explore the potential use of dynamic patient ow models to simulate the various transition states for hearing loss and ongoing decisions problems in HA use to accurately evaluate the cost effectiveness of HA use for older adults with HI [28,30,48].…”