跳到主要內容

臺灣博碩士論文加值系統

(18.97.9.169) 您好!臺灣時間:2025/02/09 23:04
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:洪詩婷
研究生(外文):Hung, Shih-Ting
論文名稱:人工耳蝸遠程調頻成本效益分析與發展 – 以美國為例
論文名稱(外文):Cost-Benefit Analysis and Development of Remote Programming for Cochlear Implants in the United States
指導教授:蔡蕙安蔡蕙安引用關係
指導教授(外文):Tsai, Hwei-An
口試委員:蔡蕙安陳詩欣蔡德明虞孝成
學位類別:碩士
校院名稱:國立陽明交通大學
系所名稱:經營管理研究所
學門:商業及管理學門
學類:企業管理學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:英文
論文頁數:44
中文關鍵詞:耳蝸式植入遠程調頻成本效益分析現場調頻美國
外文關鍵詞:Cochlear ImplantRemote ProgrammingCost-EffectivenessOn- site programmingHearing Lossthe United States
相關次數:
  • 被引用被引用:0
  • 點閱點閱:45
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
本研究旨要探討耳蝸植入遠程調頻設計是否能相對於傳統現場調頻設計,尋得更高的效益,並符合成本效益原則。在美國,約有4800萬人患有聽力障礙,其中嚴重案例主要使用耳蝸植入作為治療方案。然而,耳蝸植入現今的採用率仍然較低,而過往的研究忽視了遠程調頻這一方案。本研究旨在彌合這一差距,展示遠程調頻設計的潛力,並將其成本效益與傳統現場調頻方法進行比較。

利用馬爾可夫模型和TreeAge軟件,我們的研究評估了植入後事件和併發症,以金錢成本、QALY(生命年品質調整)和ICER(增量成本效益比)來衡量成本效益。在我們的分析中,傳統模型的ICER為88128美元,意味著每增加一個品質單位需要額外花費88128美元。我們將成本與26700美元至41400美元的閾值進行評估,發現傳統模型超出了這一範圍,降低了患者的可接受性。

總體而言,我們發現,與遠程調頻模型相比,傳統的現場調頻方式可能不具有成本效益,因為它產生了更高的成本,卻沒有明顯的附加好處。這對於經常因旅行需求而頻繁訪問植入中心的患者具有重要意義,使例行程序變得繁瑣。相比之下,遠程程式設計提供了維護的靈活性,增強了患者的長期滿意度。
Cochlear implantation explores remote programming for efficient and cost-effective solutions. In the US, around 48 million people have hearing impairment, with cochlear implants used for severe cases. Yet, implant adoption remains low, and outdated studies ignore remote programming. This study aims to bridge this gap, showcasing remote programming's potential and comparing its cost-effectiveness with on-site methods.

Using a Markov model and TreeAge software, our study assesses post-implantation events and complications, measuring cost-effectiveness in monetary terms, QALY (Quality-Adjusted Life Years), and ICER (Incremental Cost Effectiveness Ratio). In our analysis, the traditional model's ICER is $88128, implying an extra cost of $88128 for each added quality unit. We evaluate costs against a threshold of $26,700 to $41,400 to gauge acceptability and found out that the traditional model surpasses this range, lowering patient acceptability.

Overall, our findings suggest that the traditional on-site programming might not be cost-effective compared to the remote programming model, as it incurs higher costs without significant added benefits. This holds significance for patients who frequently visit the implant center due to travel demands, making the routine burdensome. In contrast, remote programming offers flexibility for maintenance, enhancing patient satisfaction in the long term.
Chinese Abstract i
English Abstract ii
Table of Contents iii
List of Figures v
List of Tables vi
1. Introduction 1
2. Industrial Stylized Facts 2
2.1 Hearing Loss in the United States 2
2.2 Cochlear Implant in the United States 3
2.3 Key Player Analysis 4
3. Literature Review 7
3.1 Cochlear Implant and Its Main Process 7
3.2 Cochlear Implant Mapping and Programming 10
3.3 The New Model of Remote Programming and Its Contribution to Cochlear Implantation 10
3.4 Markov Model 12
3.5 The Utilization of Markov Models in Healthcare and Economic Evaluation for New Treatment 13
3.6 TreeAge 13
4. Theoretical and Empirical Model 15
4.1 Model Structure 15
4.2 Hypothesis 16
4.2.1 Device Failure in Cochlear Implants: Implications for Revision Surgery and Patient Outcomes. 16
4.2.2 Major Complications in Cochlear Implants: Impacts, Management, and Surgical Considerations. 17
4.2.3 Balancing Risks and Benefits: Understanding Potential Complications of Cochlear Implant Surgery 18
5. Empirical Studies 19
5.1 Variable Specification 19
5.2 Input Parameters and Data Source 21
5.3 Empirical Results 25
6. Conclusion 35
7. References 37
Advanced Bionics. (n.d.). Phonak and Advanced Bionics: Innovating Tomorrow’s Hearing Solution, Advanced Bionics. Retrieved May, 24, 2023, from https://www.advancedbionics.com/com/en/home/about-us/phonak-ab.html.

Advanced Bionics. (n.d.). Naida CI Marvel Cochlear Implants for Adults, Advanced Bionics. Retrieved June, 8, 2023, from https://www.advancedbionics.com/us/en/home/solutions/marvel/adult.html.

Bartholomew, R.A., Rathi, V.K., Suresh, K., Sethi, R.K.V, Lee, D.J., Xiao R.(2023). Hospital-Negotiated Pricing of Cochlear Implants, Otolaryngol Head Neck Surg.

Bhadania, S. R., Vishwakarma, R., & Keshri, A. (2018). Cochlear Implant Device Failure in the Postoperative Period: An Institutional Analysis, Asian J Neurosurg, 13(4), 1066-1070.

Blanchard, M., Thierry, B., Loundon, N., Rouillon, I., Garabedian, E.-N., & Denoyelle, F. (2015). Cochlear implant failure and revision surgery in pediatric population. Annals of Otology, Rhinology & Laryngology, 124(3), 193-198.

Bowditch, S. (n.d.). Cochlear Implant Surgery and Rehabilitation. Johns Hopkins Medicine. Retrieved June, 18, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cochlear-implant-surgery.

Boyer, J., Stohl, J. (2022). MELUDIA - Online music training for cochlear implant users, Cochlear Implants Int, 23(5), 257-269.

Briggs, A., & Sculpher, M. (1998). An introduction to Markov modelling for economic evaluation. Review Pharmacoeconomics, 13(4), 397-409.

CEL for Pharma (n.d.). Do you know what a QALY is, and how to calculate it ?, CEL for Pharma. Retrieved June, 23, 2023, from https://www.celforpharma.com/insight/do-you-know-what-qaly-and-how-calculate-it.

Chen, J. M., Amoodi, H., & Mittmann, N. (2014). Cost-utility analysis of bilateral cochlear implantation in adults: a health economic assessment from the perspective of a publicly funded program, The Laryngoscope, 124(6), 1452-1458.

Cheng, A., Rubin, H.R., Powe, N.R., Mellon, N.K., Francis, H.W., & Niparko, J.K. (2000). Cost-utility of the cochlear implant in children, JAMA, 204(7), 851–856.

Cheng, L. J., Soon, S. S., Wu, D. B., Ju, H., Ng, K., & Warner-Czyz, A. D. (2019). Cost-effectiveness analysis of bilateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore, PLoS Journal One, 14(8).

Cochlear Ltd. (n.d.). About Us, Cochlear Ltd, Retrieved June, 30, 2023, from https://www.cochlear.com/au/en/about-us.
Cochlear implant report. (n.d.). When to consider an upgrade, Cochlear implant. Retrieved May, 23, from https://www.cochlear.com/us/en/home/ongoing-care-and-support/upgrading-your-device/when-to-upgrade.

Cost Helper Health. (n.d.). How much does a cochlear implant cost, Cost Helper Health. Retrieved May, 16, 2023, from https://health.costhelper.com/cochlear-implant.html.

Cutler, H., Gumbie, M., Olin, E., Parkinson, B., Bowman, R., Quadri, H., & Mann, T. (2022). The cost-effectiveness of unilateral cochlear implants in UK adults, European Journal of Health Economics, 23(5), 763-779.

Digital health outcomes. (2022). Markov model for cost-effectiveness analysis, Digital health outcome. Retrieved June, 7, 2023, from https://digitalho.com/blog/markov-model-for-cost-effectiveness-analysis.

Fitzpatrick, E.M. and Leblanc, S. (2010). Exploring the Factors Influencing Discontinued Hearing Aid Use in Patients With Unilateral Cochlear Implants, Trends in Hearing, 14(4), 199-210.

Global Market Insight. (2023). Cochlear Implants Market - By Type (Unilateral Implant, Bilateral Implant), By Patient (Adult, Pediatric), By End-use (Hospitals, ENT Clinics, Ambulatory Surgical Centers) & Forecast, 2023-2032, Global Market Insight. Retrieved 25, May, 2023, from https://www.gminsights.com/pressrelease/cochlear-implant-systems-market.

Goman, A. M., & Lin, F. R. (2016). Prevalence of Hearing Loss by Severity in the United States, American Journal of Public Health, 106(10), 1820–1822.

Gumbie, M., Olin, E., Parkinson, B., Bowman, R., & Cutler, H. (2021). The cost-effectiveness of Cochlear implants in Swedish adults, BMC Health Services Research, 21(1).

Haacker, M., Hallett, T. B., & Atun, R. (2020). On discount rates for economic evaluations in global health. Health Policy and Planning, Health Policy and Planning, 35(1), 107–114.

Horsman, J., Furlong, W., Feeny, D., & Torrance, G. (2003). The Health Utilities Index (HUI®): Concepts, measurement properties and applications, Health and Quality of Life Outcomes. Retrieved 20, May, 2023 from https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-1-54.

Hughes, M. L., Goehring, J. L., Baudhuin, J. L., Diaz, G. R., Sanford, T., Harpster, R., & Valente, D. L. (2012). Use of telehealth for research and clinical measures in cochlear implant recipients: a validation study, Journal of Speech, Language, and Hearing Research, 55(4), 1112-1127.

IBM (n.d.). What is Monte Carlo simulation, IBM. Retrieved 26, May, 2023, from https://www.ibm.com/topics/monte-carlo-simulation.

I Hear Foundation. (2023). Cochlear implant mapping, Hear Foundation. Retrieved 18, May, 2023 from http://www.ihearfoundation.org/cochlear-implant/mapping/.

Igarashi, A., Maruyama-Sakurai, K., Kubota, A., Akiyama, H., Yajima, T., Kohsaka, S., & Miyata, H. (2022). Cost-Effectiveness Analysis of Initiating Type 2 Diabetes Therapy with a Sodium-Glucose Cotransporter 2 Inhibitor Versus Conventional Therapy in Japan, Diabetes Therapy, 13, 1367-1381.

Jeppesen, J., & Faber, C. E. (2013). Surgical complications following cochlear implantation in adults based on a proposed reporting consensus, Acta Otolaryngol, 133(10), 1012-1021.

Kbv research. (2019). Asia Pacific Cochlear Implants Market By Fitting Type (Unilateral Implantation and Bilateral Implantation) By End Use (Pediatrics and Adults), Market Research Report, Retrieved June, 23, 2023, from https://www.kbvresearch.com/asia-pacific-cochlear-implants-market/.

Kim, S. Y., Kim, M. B., Chung, W. H., Cho, Y. S., Hong, S. H., & Moon, I. J. (2020). Evaluating Reasons for Revision Surgery and Device Failure Rates in Patients Who Underwent Cochlear Implantation Surgery, JAMA Otolaryngol Head Neck Surg, 146(5), 414-420.

Kubo, T., Matsuura, S., & Iwaki, T. (2005). Complications of cochlear implant surgery, Operative Techniques in Otolaryngology-Head and Neck Surgery, 16(2), 154-158.
Kumar, R. S., Mawman, D., Sankaran, D., Melling, C., O'Driscoll, M., Freeman, S. M., & Green, K. M. J. (2016). Cochlear implantation in early deafened, late implanted adults: Do they benefit?, Cochlear Implants International, 17(1), 22-25.

Kyriafinis, G., Vital, V., Psifidis, A., Constantinidis, J., Nikolaou, A., Hitoglou-Antoniadou, M., & Kouloulas, A. (2007). Preoperative evaluation, surgical procedure, follow up and results of 150 cochlear implantations. Hippokratia, 11(2), 77-82.

Lang, D. L., Lopert, R., & Hill, S. R. (2003). Use of pharmacoeconomics in prescribing research. Part 5: modelling--beyond clinical trials, Journal of Clinical Pharmacy and Therapeutics, 28(5), 433-439.

Lassig, A. D., Zwolan, T. A., & Telian, S. A. (2005). Cochlear Implant Failures and Revision. Otology & Neurotology, 26(4), 624-634.

Lin, W.C., Yen, A. M.F., Chang, C.M., Chao, C.H., & Chen, T. H. H. (2009). Computer-aided system for health economic evaluation, Journal of Evaluation in Clinical Practice, 15(5), 797-803.

Lippitt, C. (2018). Are you a cochlear implant candidate?, Audiologists outline the process, Cochlear Services. Retrieved 16, May, 2023, from https://hearandnow.cochlear.com/hearing-solutions/services/are-you-a-cochlear-implant-candidate-audiologists-outline-the-process/.

Liu, H., Liu, H. X., Kang, H. Y., Gu, Z., & Hong, S. L. (2016). Evaluation on health-related quality of life in deaf children with cochlear implant in China, International Journal of Pediatric Otorhinolaryngology, 88, 136-141.


Megerian, C. A., & Meyers, A. D. (2022). Cochlear Implant Surgery. Medscape. Retrieved May, 14, 2023, from https://emedicine.medscape.com/article/857242-overview?reg=1.
MED-EL. (n.d.). The History of MED-EL, MED-EL. Retrieved 2, May, 2023, from https://www.medel.com/about-medel/our-history.

Meludia. (n.d.). MED-EL and Meludia sign official partnership, Meludia. Retrieved 13, May, 2023, from https://www.meludia.com/en/cochlear-implant/.

Mertes, J., & Chinnici, J. (2006, February 13). Cochlear Implants — Considerations in Programming for the Pediatric Population. Starkey Genesis, Pediatrics, Aural Habilitation - Children, Hearing Aids - Children, Cochlear Implants, Audiology Online. Retrieved 11, May, 2023, from https://www.audiologyonline.com/articles/cochlear-implants-considerations-in-programming-1011.

Mordor Intelligence. (n.d.). Cochlear implants market size & share analysis – growth trends & forecoasts (2023-2028), Mordor Intelligence. Retrieved 10, June, 2023, from https://www.mordorintelligence.com/industry-reports/cochlear-implants-market.

Nassiri, A. M., Saoji, A. A., DeJong, M. D., Tombers, N. M., Driscoll, C. L. W., Neff, B. A., Haynes, D. S., & Carlson, M. L. (2022). Implementation Strategy for Highly-Coordinated Cochlear Implant Care With Remote Programming: The Complete Cochlear Implant Care Model, Otology and Neutrology, 43(8), 916-923.

Nassiri, A. M., Holcomb, M. A., Perkins, E. L., Bucker, A. L., Prentiss, S. M., Welch, C. M., ... Carlson, M. L. (2022). Catchment Profile of Large Cochlear Implant Centers in the United States, Otolaryngology-Head and Neck Surgery, 167(3), 545-551.

Ozer, F., Yavuz, H., Yilmaz, I., & Ozluoglu, L. N. (2021). Cochlear Implant Failure in the Pediatric Population, Journal of Audiology and Otology, 25(4), 217-223.

Parisier, S.C., Elexiades, G., Hoffman, R., & Madell, J. R. (2004). Cochlear implants: obstacles limiting application, International Congress Series, 1273, 255-258.

Peaper-Fillyaw, R., Bruce, M., Gavett, E., Klick, P., McCollum, M., Robinson, L., & monitoring Vice-President, C.A.P.C.S.D. (2013). COUNCIL OF ACADEMIC PROGRAMS IN COMMUNICATION SCIENCES AND DISORDERS.

Phonak hearing system. (2003). Media Release: Joint Venture with Cochlear Ltd. Phonak hearing system. Retrieved 4, May, 2023, from https://e2.marco.ch/publish/sonova/ws_press_release/20030819_en_679d681a50fb34dae6b66f70139c55f8dfba0a6d_com_corp_joint_venture_cochlear_xx.pdf.

Pitotech. (n.d.). 醫療管理/決策/訴訟分析軟體 TreeAge, Pitotech. Retrieved 7, May, 2023, from https://www.pitotech.com.tw/contents/en-us/p10138_TreeAge.html.

Prosser, L. A., Ray, G. T., O’Brien, M., Kleinman, K., Santoli, J., & Lieu, T. A. (2004). Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine, Pediatrics, 113(2), 283-290.

Rosenzweig, E. A. (2011). Mapping a Cochlear Implant, Elizabeth A. Rosenzweig. Retrieved 4, June, 2023, from https://auditoryverbaltherapy.net/2011/10/24/mapping-a-cochlear-implant/.

Sato, R. C., & Zouain, D. M. (2010). Markov models in health care, Scielo 25 Brazil. Retrieved 7, May, 2023, from https://www.scielo.br/j/eins/a/bfLZKsX4z4F7fgM76RfWfJN/?lang=en.

Schepers, K., Steinhoff, H.-J., Ebenhoch, H., Böck, K., Bauer, K., Rupprecht, L., et al. (2019). Remote programming of cochlear implants in users of all ages, Audiology, 58(4), 251-257.

Shapiro, W. H., & Bradham, T. S. (2012). Cochlear Implant Programming, Otolaryngologic Clinics of North America, 45(1), 111-127.

Skarzynski, P. H., Wojciechowski, M., Skarzynska, M. B., & Fronczak, P. (2021). Sense of taste in patients after cochlear implantation-preliminary study, African Health Sciences, 21(4), 1801-1807.

Slager, H. K., Jensen, J., Kozlowski, K., Teagle, H., Park, L. R., Biever, A., & Mears, M. (2019), Remote Programming of Cochlear Implants, Otology & Neurotology, 40(3), 260-266.

Sorkin, D. L. (2013). Cochlear implantation in the world's largest medical device market: Utilization and awareness of cochlear implants in the United States, Cochlear Implants International, 14 (1), 4-12.

Stanford Medicine Healthcare Report. (n.d.). What to expect from a cochlear implant, Stanford Medicine Healthcare. Retrieved 23, May, 2023, from https://stanfordhealthcare.org/medical-treatments/c/cochlear-implants/what-to-expect.html.

Summerfield, A. Q., Barton, G. R., & the UK Cochlear Implant Study Group. (2019). Sensitivity of EQ-5D-3L, HUI2, HUI3, and SF-6D to changes in speech reception and tinnitus associated with cochlear implantation, Quality of Life Research, 28(5), 1145-1154.

Sun, X., & Faunce, T. (2008). Decision-analytical modelling in health-care economic evaluations, The European Journal of Health Economics, 9, 313-323.

TreeAge.(n.d.). Cost benefit analysis, TreeAge. Retrieved 16, May, 2023, from https://www.treeage.com/hc-features/cost-effectiveness/.

UCI Otolaryngology Head and Neck Surgery. (n.d.). Cochlear implant evaluation and mapping services, UCI Otolaryngology Head and Neck Surgery. Retrieved 12, May, 2023, from https://uciaudiology.com/hearing-aids-cochlear-implants/cochlear-implant-evaluation-mapping-services/.

Van Wilder, L., Devleesschauwer, B., Clays, E., Van der Heyden, J., Charafeddine, R., Scohy, A., & De Smedt, D. (2022). QALY losses for chronic diseases and its social distribution in the general population: Results from the Belgian Health Interview Survey, BMC Public Health, 22, 1304.

Victory, J. (2022). Hearing loss statistics at a glance, Health Hearing. Retrieved 4, June, 2023, from https://www.healthyhearing.com/report/52814-Hearing-loss-statistics-at-a-glance.

Wang, J. T., Wang, A. Y., Psarros, C., & Da Cruz, M. (2014). Rates of revision and device failure in cochlear implant surgery: A 30-year experience, The Laryngoscope, Otology/Neurotology, 124(10), 2392-2399.

Wyatt, J.R., Niparko, J.K., Rothman, M., deLissovoy, G. (1996). Cost utility of the multichannel cochlear implant in 258 profoundly deaf individuals, Laryngoscope, 106, 816–821.

York Health Economics Consortium.(2016). An Introduction to Markov mode, York Health Economics Consortium. Retrieved 7, June, 2023, from https://yhec.co.uk/glossary/markov-model/.
電子全文 電子全文(網際網路公開日期:20260810)
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top