Cost‐Effectiveness of Canal Wall Up Tympanoplasty With and Without Obliteration in Cholesteatoma Surgery

OBJECTIVE: To determine the cost-effectiveness of the bony obliteration tympanoplasty compared with canal wall up without obliteration in cholesteatoma surgery from a healthcare payer perspective. STUDY DESIGN: State-transition Markov model. SETTING: Tertiary care center in the Netherlands. METHODS: A state-transition Markov model was developed to evaluate costs and health outcomes over a 5-year time horizon. Health benefits were quantified in quality-adjusted life years. All costs were expressed in euros. Transition probabilities and complication rates were derived from a propensity score-matched retrospective cohort study (n = 110 ears). Matching variables included cholesteatoma origin, disease extent according to the STAM classification, and prior middle ear surgery. Deterministic one-way sensitivity analyses and probabilistic sensitivity analyses were conducted. RESULTS: The model estimated 5‑year costs and health outcomes for a 40‑year‑old patient undergoing either bony obliteration tympanoplasty or the canal wall up technique without mastoid obliteration. Bony obliteration tympanoplasty resulted in higher mean costs (€5954 vs €4844), mainly driven by longer operative time. However, it also yielded more quality-adjusted life years over 5 years (2.76 vs 2.47). This corresponded to an incremental cost-effectiveness ratio of €3855 per additional quality-adjusted life year gained, which is well below commonly accepted willingness-to-pay thresholds. Probabilistic sensitivity analysis confirmed the robustness of these findings, indicating that bony obliteration tympanoplasty is cost-effective in 97% of simulations at a willingness-to-pay of €50,000. CONCLUSION: Bony obliteration tympanoplasty is a cost-effective alternative to the canal wall up technique without mastoid obliteration for cholesteatoma surgery and should be considered in surgical planning.