Method: A model-based early economic analysis compared the surgical insertion of grommets with two non-surgical alternatives (hearing-aids; do-nothing) in the management of persistent bilateral OME in children with CP. The model assumed a 2-year time horizon and UK NHS perspective. Outcomes were valued using Quality-Adjusted Life-Years (QALYs) estimated by linking published utility values with hearing gain (measured in decibels). Multiple data sources were used including: systematic reviews of the effectiveness, resource use and utility literature and supplemented with published expert opinion. Probabilistic sensitivity analysis was used to quantify parameter uncertainty. The results of an expected value of perfect information analysis was combined with the findings from the qualitative views of children and parents about willingness to take part in a potential trial and important outcomes of OME management.
Result: The probabilistic incremental cost-effectiveness ratio for grommets insertion versus hearing-aids was £14,333 per QALY (95% CI: £8,311 to £20,355) and versus do-nothing was £18,036 per QALY (-£3,790 to £39,862). A key source of uncertainty was the assumed link with changes in utility values and hearing gain. The expected value of perfect information analysis indicated that the value of future research work in this area is worthwhile. Children and parents had clear ideas about outcomes that were important to them, which extended beyond hearing gain. However, more than half of the parents (63%) were negative or unsure about their child taking part in a future trial.
Conclusion: This study has shown that value of information analysis has an important role in informing the need for future research but should be part of a wider programme of work to understand the feasibility and design of future trials.