Dynamic modeling in medical technology assessment - Fitting hearing aids in the Netherlands

Objectives: The main objective of this article is to demonstrate the useful ness of dynamic modeling for an economic assessment of technology in health care. Specifically, this approach is applied to assess the impact of the u se of hearing aids in Dutch health care. Methods: The population is divided into different health classes between wh ich, over time, transitions occur. Transition probabilities are derived fro m exogenous data. The transitions are associated with economic and societal costs and benefits. People who are satisfied with their hearing aids exper ience benefits. These benefits are expressed by quality-adjusted life-years (QALYs). Costs are made during transitions (mainly the fitting of hearing aids). A cohort analysis is carried out, starting with people in a particul ar age group. The starting point is a fixed number of people within this ag e group, who are followed during their whole lifetime. Results: Costs per QALY ratios are calculated for two health programs. The Fitting Hearing Aid Program describes the present situation in the Netherla nds; the Post-purchase Counseling Hearing Aid Program is a hypothetical add ition to the first program, where an intervention based on a Dutch study is undertaken to improve satisfaction with hearing aids. Future benefits and costs are discounted at a rate of 5%. Conclusions: The dynamic modeling approach provides a more realistic pictur e than a static approach. Particularly, the cost-effectiveness of the Fitti ng Hearing Aid Program is compared with the Post-purchase Counseling Hearin g Aid Program.