Abstract
Cystic fibrosis (CF) patients that receive high-dose aminoglycosides can acquire inner ear damage and subsequently hearing loss. This study evaluated the cost-effectiveness of a pharmacist-implemented routine hearing screening for ototoxicity among pediatric patients using a clinically validated tablet audiometer to increase audiology referral rates and earlier detection. A Markov decision-analytic model was developed in Excel to assess the cost-effectiveness of implementing routine screening with monthly cycles over a three-year time horizon. The model measured the difference in promptly detected hearing loss, delayed detected hearing loss, and undetected hearing loss as compared to current screening practices. Screening outcomes, utilities, and cost inputs were obtained through systematic literature reviews. Primary model outcomes included total healthcare costs and quality-adjusted life years (QALYs) gained with a 3% yearly discount. One-way and two-way sensitivity analyses were conducted to evaluate model uncertainty. An additional analysis of chronic high-dose aminoglycoside users was performed to account for differences in patient populations. In a hypothetical cohort of one hundred patients over three years, routine screening using a tablet audiometer increased promptly detected hearing loss by eight patients. There was an incremental gain of 3.2 QALYs at an increased cost of $328,901 when compared to current screening practices. This resulted in an incremental cost-effectiveness ratio (ICER) of $103,297 per QALY. When model inputs were varied in one-way sensitivity analyses, the ICER ranged between $64,078 and $257,098 per QALY. When only considering chronic users, the ICER increased to $115,266 per QALY. There is currently no standardized protocol for assessing ototoxicity in CF centers. Utilizing a tablet audiometer for routine hearing screening appears to be a cost-effective option at a $150,000 per QALY threshold when only considering the immediate utility gained. This analysis did not examine the long-term benefit of early detection in speech and language development for pediatric patients.
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