Abstract
A cochlear implant is a small electronic device that provides a sense of sound for the user, which can be used unilaterally or bilaterally. Although there is advocacy for the benefits of binaural hearing, the high cost of cochlear implant raises the question of whether its additional benefits over the use of an acoustic hearing aid in the contralateral ear outweigh its costs. This cost-effectiveness analysis aimed to separately assess the cost-effectiveness of simultaneous and sequential bilateral cochlear implantations compared to bimodal hearing (use of unilateral cochlear implant combined with an acoustic hearing aid in the contralateral ear) in children with severe-to-profound sensorineural hearing loss in both ears from the Singapore healthcare payer perspective. Incremental quality-adjusted life year (QALYs) gained and costs associated with bilateral cochlear implants over the lifetime horizon were estimated based on a four-state Markov model. The analysis results showed that, at the 2017 mean cost, compared to bimodal hearing, patients receiving bilateral cochlear implants experienced more QALYs but incurred higher costs, resulting in an incremental cost-effectiveness ratio (ICER) of USD$60,607 per QALY gained for simultaneous bilateral cochlear implantation, and USD$81,782 per QALY gained for sequential bilateral cochlear implantation. The cost-effectiveness of bilateral cochlear implants is most sensitive to utility gain associated with second cochlear implant, and cost of bilateral cochlear implants. ICERs increased when the utility gain from bilateral cochlear implants decreased; ICERs exceeded USD$120,000 per QALY gained when the utility gain was halved from 0.03 to 0.015 in both simultaneous and sequential bilateral cochlear implantations. The choice of incremental utility gain associated with the second cochlear implant is an area of considerable uncertainty.
Highlights
In Singapore, about 1.7 per 1,000 babies are diagnosed with severe-to-profound hearing loss or deafness at a median age of diagnosis of 2.7 months [1]
The aim of this study is to evaluate bilateral cochlear implants’ cost-effectiveness compared to bimodal hearing in children with severe-to-profound sensorineural hearing loss in both ears, from the Singapore healthcare payer perspective
Our results showed that when simultaneous and sequential bilateral cochlear
Summary
In Singapore, about 1.7 per 1,000 babies are diagnosed with severe-to-profound hearing loss or deafness at a median age of diagnosis of 2.7 months [1]. Cost effectiveness of bilateral cochlear implants for children esteem in children [2]. A cochlear implant is a small electronic device that stimulates the auditory nerve fibres directly to convey information to the brain on the amplitude and frequency of the sound signals [3], providing a sense of sound for the user who suffers from severe-to-profound sensorineural hearing loss [4]. For children with poor residual hearing in the non-implanted ear, functional benefits may be limited. Unilateral cochlear implant can provide substantial communication benefits compared to no cochlear implant,[8] children without additional disabilities receiving unilateral cochlear implant continue to fare worse than their normal hearing peers in academic performance, measured in written and oral language[9,10,11], mathematics[11], and grade failure rates[12]
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