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A model-based cost-effectiveness analysis of a grommets-led care pathway for children with cleft palate affected by otitis media with effusion

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Abstract

There is a paucity of evidence to guide the management of otitis media with effusion (OME), which is a common problem causing significant hearing impairment in children with cleft palate. The insertion of grommets is currently being used to correct hearing impairment and prevent complications of unmanaged OME, but there is ongoing discussion about whether the benefits of grommets outweigh the costs and risks. A decision-tree model was developed to assess the surgical insertion of grommets with two non-surgical alternatives (hearing-aids and do-nothing strategies) in cleft palate children with persistent bilateral OME. The model assumed a 2-year time horizon and a UK National Health Service perspective. Outcomes were valued using quality-adjusted life-years (QALYs) estimated by linking utility values with potential hearing gains measured in decibels. Multiple data sources were used, including reviews of the clinical effectiveness, resource use and utility literature, and supplemented with expert opinion. Uncertainty in the model parameters was assessed using probabilistic sensitivity analysis. Expected value of perfect information analysis was used to calculate the potential value of future research. The results from the probabilistic sensitivity analysis indicated that the grommets strategy was associated with an incremental cost-effectiveness ratio of £9,065 per QALY gained compared with the do-nothing strategy, and the hearing-aids strategy was extended dominated by the grommets strategy. The population expected value of perfect information was £5,194,030 at a willingness to pay threshold of £20,000 per QALY, implying that future research could be potentially worthwhile. This study found some evidence that the insertion of grommets to manage cleft palate children with bilateral OME is likely to be cost-effective, but further research is required to inform this treatment choice.

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Notes

  1. Data from the CRANE Database showed there were 800 children born with CP in England, Wales and Northern Ireland in 2012 [http://www.craniofacialsociety.org.uk/downloads/CRANE%20Annual%20Report%202013%20(Final).pdf]. Of which, 720 (90 % [2, 4–6] of 800) were assumed to have OME.

  2. Armstrong [15] first described the use of grommets in 1954, and since then, use of grommets to restore hearing to normal has been increased. Given the historical longevity of the technology revealed in the literature, it seemed reasonable to assume that grommets will be used for at least another 10 years before a new technology comes along and replaces grommet technology.

  3. As recommended by the NICE reference case [25].

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Acknowledgments

This study was supported by the National Institute for Health Research Health Technology Assessment Programme at the National Health Service and the Healing Foundation, UK. The Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) Study Management Group (Iain Bruce, Peter Callery, Nicola Harman, Syed Mohiuddin, Kevin O’Brien, Katherine Payne, Bill Shaw, Tri Tat, Stephanie Tierney and Paula Williamson). The Healing Foundation Cleft and Craniofacial Clinical Research Centre, University of Manchester, and Paul Jacklin (senior health economist, National Collaborating Centre for Women’s and Children’s Health, UK) are thanked for providing advice and guidance.

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Authors and Affiliations

  1. The Healing Foundation Cleft and Craniofacial Clinical Research Centre, University of Manchester, Manchester, UK

    Syed Mohiuddin, Kevin O’Brien & Iain Bruce

  2. Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Syed Mohiuddin & Katherine Payne

  3. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK

    Elisabeth Fenwick

  4. School of Dentistry, University of Manchester, Manchester, UK

    Kevin O’Brien

  5. Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester, UK

    Iain Bruce

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  1. Syed Mohiuddin
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  2. Katherine Payne
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  3. Elisabeth Fenwick
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  4. Kevin O’Brien
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  5. Iain Bruce
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Correspondence to Syed Mohiuddin.

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Mohiuddin, S., Payne, K., Fenwick, E. et al. A model-based cost-effectiveness analysis of a grommets-led care pathway for children with cleft palate affected by otitis media with effusion. Eur J Health Econ 16, 573–587 (2015). https://doi.org/10.1007/s10198-014-0610-8

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