Cost‐Effectiveness of Canal Wall Up Tympanoplasty With and Without Obliteration in Cholesteatoma Surgery
Tom R. von Hebel, Martijn A. H. Oude Voshaar, Steven W. Mes, Bernd Kremer, Robert J. Pauw, Hylke F. E. van der ToomAbstract
Objective
To determine the cost‐effectiveness of the bony obliteration tympanoplasty compared with canal wall up without obliteration in cholesteatoma surgery from a healthcare payer perspective.
Study design
State‐transition Markov model.
Setting
Tertiary care center in the Netherlands.
Methods
A state‐transition Markov model was developed to evaluate costs and health outcomes over a 5‐year time horizon. Health benefits were quantified in quality‐adjusted life years. All costs were expressed in euros. Transition probabilities and complication rates were derived from a propensity score–matched retrospective cohort study (n = 110 ears). Matching variables included cholesteatoma origin, disease extent according to the STAM classification, and prior middle ear surgery. Deterministic one‐way sensitivity analyses and probabilistic sensitivity analyses were conducted.
Results
The model estimated 5‑year costs and health outcomes for a 40‑year‑old patient undergoing either bony obliteration tympanoplasty or the canal wall up technique without mastoid obliteration. Bony obliteration tympanoplasty resulted in higher mean costs (€5954 vs €4844), mainly driven by longer operative time. However, it also yielded more quality‐adjusted life years over 5 years (2.76 vs 2.47). This corresponded to an incremental cost‐effectiveness ratio of €3855 per additional quality‐adjusted life year gained, which is well below commonly accepted willingness‐to‐pay thresholds. Probabilistic sensitivity analysis confirmed the robustness of these findings, indicating that bony obliteration tympanoplasty is cost‐effective in 97% of simulations at a willingness‐to‐pay of €50,000.
Conclusion
Bony obliteration tympanoplasty is a cost‐effective alternative to the canal wall up technique without mastoid obliteration for cholesteatoma surgery and should be considered in surgical planning.