Tinnitus #2: The Cost of Tinnitus Therapy
Many pharmacologic treatments have been suggested for tinnitus, but most claims of effectiveness do not withstand scientific evaluation or meta-analysis (Hesse, 2016). Multiple non-pharmacologic therapies are either currently available or are being developed for tinnitus patients (electric and magnetic stimulation, vagal nerve stimulation, acupuncture, acoustic stimulation, music therapy, hearing aids, cochlear implants, cognitive behavioral therapy, tinnitus retraining therapy, and others), but gaps in evidence of effectiveness exist for all of these (Hesse, 2016). As the medical community continues to combat the suffering caused by tinnitus, we must consider not just the effectiveness of these treatments, but also the cost to the patients and the healthcare system as a whole.
Patients suffering from severe tinnitus are understandably willing to undergo, and pay for, significant treatments. In one study, 19% of tinnitus patients would accept a brain implant if it would completely eliminate tinnitus, and 20% would be willing to spend more than $25,000 for such relief (Tyler, 2012). In a subsequent trial by the same research group, 40% of tinnitus patients had already spent up to $10,000 on tinnitus therapies (Engineer et al., 2013.)
However, such spending is not necessarily correlated with improved patient satisfaction and is difficult to sustain on a large scale. While annual per-patient health care costs related to chronic tinnitus treatment exceed $2,000 in the United States, one study found no correlation between patient satisfaction and per-patient expenditures or number of clinic visits (Goldstein et al., 2015).
One criterion by which spending on tinnitus can be measured on a macro level is the gain in quality adjusted life years (QALY). QALYs represent the number of years in good health that can be expected for a patient who pursues tinnitus treatment relative to a patient who receives no directed treatment and self-manages his or her symptoms. A study of tinnitus treatment in Great Britain found the cost per QALY gained varied from simple education and reassurance by the general practitioner (£258, or approximately $335) to referral to audiology and ENT (£82,523, or approximately $107,000). Overall, the cost for effective tinnitus treatment was still high, with an average cost per QALY gained of £10,616 (or approximately $13,800) and a total annual cost to the National Health Service of £750 million (or approximately $975 million) (Stockdale et al., 2017) ($ figures based on exchange rate of $1.30 per £).
In the United States, the societal cost of tinnitus treatment is illustrated by the large expenditure to its veterans for this condition. In 2017, 296,000 veterans began receiving service-connected disability payments, resulting in a cumulative payout of $3.51 billion for new disability claims. While the specific cost of tinnitus claims is not available, this cost was likely significant as tinnitus claims were by far the most common (159,800 claims, representing 54% of new benefit recipients) (2017 Annual Benefits Report, U.S. Department of Veterans Affairs). In summary, it is clear that current tinnitus treatments are expensive to the patient and to society, yet do not necessarily lead to improved patient satisfaction. This high financial burden
is compounded by the reduction in quality of life and associated comorbid conditions, which will be described in the next articles in this series about tinnitus.
References Engineer N.D., Rosellini, W.M., & Tyler, R.S. (2013). Willingness to accept and pay for implantable tinnitus treatments: a survey. Neuromodulation, 16(2), 154-162.
Goldstein, E., Ho, C-X., Hanna, R., Elinger, C., Yaremchuk, K.L., Seidman, M.D. ,& Jesse, M.T. (2015). Cost of care for subjective tinnitus in relation to patient satisfaction. Otolaryngol Head Neck Surg, 152(3), 518-523.
Hesse, G. (2016). Evidence and evidence gaps in tinnitus therapy. GMS Curr Top Otolaryngol Head Neck Surg, 15, 1-42.
Stockdale, D., McFerran, D., Brazier, P., Pritchard, C., Kay, T., Dowrick, C., & Hoare, D.J. (2017). An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Services Research, 17, 1-9.
Tyler, R.S. (2012). Patient preferences and willingness to pay for tinnitus treatments. J Am Acad Audiol, 23(2), 115-25.
Authors David Hicks, M.D.: Dr. Hicks directs business development at Turner Scientific, and has significant training and experience in clinical treatment of ear disorders. Contact: firstname.lastname@example.org
Jeremy Turner, Ph.D.: Dr. Turner is the founder and Chief Scientific Officer at Turner Scientific. He completed his Ph.D. in auditory neuroscience, and has more than 22 years’ experience in preclinical hearing loss, tinnitus, and ototoxicity research. Contact: email@example.com