Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial

• Published in: Otology & neurotology Vol. 37; no. 1; p. 38
• Main Authors: Smulders, Yvette E, van Zon, Alice, Stegeman, Inge, van Zanten, Gijsbert A, Rinia, Albert B, Stokroos, Robert J, Free, Rolien H, Maat, Bert, Frijns, Johan H M, Mylanus, Emmanuel A M, Huinck, Wendy J, Topsakal, Vedat, Grolman, Wilko
• Format: Journal Article
• Language: English
• Published: United States 01.01.2016
• Subjects: Adolescent; Adult; Age Factors; Aged; Cochlear Implantation - economics; Cochlear Implants - economics; Cost-Benefit Analysis; Deafness - economics; Deafness - therapy; Female; Functional Laterality; Health Care Costs; Health Status; Humans; Life Expectancy; Male; Middle Aged; Quality-Adjusted Life Years; Treatment Outcome; Young Adult
• ISSN: 1537-4505
• DOI: 10.1097/MAO.0000000000000901

To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. Randomized controlled trial (RCT). Five tertiary referral centers. Thirty-eight postlingually deafened adults eligible for cochlear implantation. A cost-utility analysis was performed from a health insurance perspective. Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy. Direct costs for unilateral and bilateral CI were €43,883 ± €11,513(SD) and €87,765 ± €23,027(SD) respectively. Annual costs from the second year onward were €3,435 ± €1,085(SD) and €6,871 ± €2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing. This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.