Cost-effectiveness of specialized treatment based on cognitive behavioral therapy versus usual care for tinnitus

OBJECTIVE: To evaluate the cost-effectiveness of specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy, compared with care as usual. DESIGN: Randomized controlled trial including an economic evaluation from a health-care and societal perspective, using a one-year time horizon. SETTING: Audiologic center. PATIENTS: A referred sample of 626 patients with tinnitus were eligible for participation. Approximately 492 patients were included in the study. Eighty-six (35%) of 247 patients in the usual care group, and 74 (30%) of 245 patients in the specialized care group were lost to follow-up by month 12. MAIN OUTCOME MEASURES: Quality adjusted life years (QALYs) as measured with the Health Utilities Index Mark III and cost in US dollars. RESULTS: Compared with patients receiving usual care, patients who received specialized care gained on average 0.015 QALYs (95% bootstrapped confidence interval [BCI], -0.03 to 0.06). The incremental costs from a societal perspective are $357 (95% BCI,-$1,034 to $1,785). The incremental cost per QALY from a societal perspective amounted to $24,580. The probability that SC is cost-effective from a societal perspective is 58% for a willingness to pay for a QALY of $45,000. CONCLUSION: Specialized multidisciplinary tinnitus treatment based on cognitive behavioral therapy is cost-effective as compared with usual care. Although uncertainty surrounding the incremental costs and effects is considerable, sensitivity analysis indicated that cost-effectiveness results were robust.