Disorders of the inner ear can cause symptoms such as vertigo, tinnitus, and hearing loss. Betahistine and cinnarizine with or without dimenhydrinate are used in people with vertigo disorders including Ménière’s disease. These medicines are reimbursed by the compulsory health insurance scheme, but their clinical efficacy is unclear. This report evaluates the efficacy and safety of the treatments in patients with Ménière’s disease, vertigo disorders or tinnitus, as well as cost-effectiveness and the budgetary impact.
A systematic literature search found a total of 10 studies on the various questions. Treatment of Ménière’s disease for 9 months with betahistine probably makes little or no difference compared to placebo with regard to vertigo and quality of life. The studies suggest that, compared to placebo, betahistine shows little or no difference for tinnitus and hearing loss, and also for serious adverse events. For various vertigo disorders, the evidence on the effects of betahistine after 3 months is very uncertain. For tinnitus, the evidence on the effects of cinnarizine after 10 weeks is also very uncertain. In persons with various vertigo disorders, 4 weeks’ treatment with cinnarizine in combination with dimenhydrinate probably leads to an improvement in vertigo symptoms. Neither of the two treatments was associated with serious adverse events. With regard to cost-effectiveness over a 5-year period, the use of cinnarizine with dimenhydrinate for the treatment of vertigo with or without Ménière’s disease permits savings of CHF 1.2 million. This treatment was also better regarding the costs and the benefit in comparison to no treatment. Overall, the budgetary impact was projected to be CHF 17.2 million for betahistine and CHF 0.8 million for cinnarizine without dimenhydrinate. From an ethical, social and organisational perspective, possible constraints arise due to delayed treatment, social isolation and reduced quality of life. Driving restrictions for people with Ménière’s disease are relevant from a legal viewpoint.
The report concludes that evidence is limited. Treatment with betahistine of people with Ménière’s disease or with various vertigo disorders may show little or no difference compared to placebo. The effects of betahistine on various vertigo disorders and the effects of cinnarizine on tinnitus are very uncertain. Treatment with cinnarizine combined with dimenhydrinate probably results in an improvement in vertigo for people with various vertigo disorders. The medicine is probably well tolerated. Treatment of Ménière’s disease and other vertigo disorders with cinnarizine and dimenhydrinate leads to projected savings of CHF 1.2 million. Over a 5-year period, the budgetary impact is CHF 17.2 million for betahistine and CHF 0.8 million for cinnarizine without dimenhydrinate.
