Cost-utility analysis of bilateral cochlear implantation in adults: a health economic assessment from the perspective of a publicly funded program.

OBJECTIVES/HYPOTHESIS: To determine the cost-effectiveness of bilateral cochlear implantation (CI) in deaf adults.

STUDY DESIGN: Cost-utility analysis.

METHODS: Ninety patients and 52 health professionals served as proxies to estimate the benefit of bilateral cochlear implantation, utilizing the Health Utility Index. Three scenarios were created to reflect 1) deafness without intervention, 2) unilateral CI, and 3) bilateral CI. Cost evaluation reflected the burden on a publicly funded healthcare system. The base case included 25 years of service provision, processor upgrades every 5 years, 50% price reduction for second side, and 15% failure rate. Discounting and sensitivity analyses were applied.

RESULTS: Costs were $63,632 (unilateral CI), $111,764 (bilateral CI), and $48,132 (incremental cost of second CI). The health preference gained from no intervention to unilateral CI, and to bilateral CI were 0.270 and 0.305. Incremental utility gained by the second implant was 11.5% of total. The incremental cost-utility ratio (ICUR) was $14,658/quality-adjusted life year (QALY) for bilateral CI compared to no intervention. It was stable regardless of discounting or sensitivity analyses. ICUR was $55,020/QALY from unilateral to bilateral CI with higher uncertainties. It improved with differential discounting, further second-side price reduction, and reduced frequency of processor upgrades. ICUR worsened with reduced length of use and higher failure rates.

CONCLUSIONS: Sequential bilateral CI was cost-effective when compared to no intervention, although gains were made mostly by the first implant. Cost-effectiveness compared to unilateral implantation was borderline but improved through base case variations to reflect long-term gains or cost-saving measures.

LEVEL OF EVIDENCE: 2C.