Abstract
ObjectiveThe National Institute for Health and Care Excellence (NICE) updated its eligibility criteria for unilateral cochlear implants (UCIs) in 2019. NICE claimed this would not impact the cost-effectiveness results used within its 2009 technology appraisal guidance. This claim is uncertain given changed clinical practice and increased healthcare unit costs. Our objective was to estimate the cost-effectiveness estimates of UCIs in UK adults with severe to profound hearing loss within the contemporary NHS environment.MethodsA cost–utility analysis employing a Markov model was undertaken to compare UCIs with hearing aids or no hearing aids for people with severe to profound hearing loss. A clinical pathway was developed to estimate resource use. Health-related quality of life, potential adverse events, device upgrades and device failure were captured. Unit costs were derived mostly from the NHS data. Probabilistic sensitivity analysis further assessed the effect of uncertain model inputs.ResultsA UCI is likely to be deemed cost-effective when compared to a hearing aid (£11,946/QALY) or no hearing aid (£10,499/QALY). A UCI has an 93.0% and 98.7% likelihood of being cost-effective within the UK adult population when compared to a hearing aid or no hearing aid, respectively. ICERs were mostly sensitive to the proportion of people eligible for cochlear implant, discount rate, surgery and device costs and processor upgrade cost.ConclusionUCIs remain cost-effective despite changes to clinical practice and increased healthcare unit costs. Updating the NICE criteria to provide better access UCIs is projected to increase annual implants in adults and children by 70% and expenditure by £28.6 million within three years. This increased access to UCIs will further improve quality of life of recipients and overall social welfare.
Highlights
Around 11 million people in the UK live with permanent hearing loss, most of which results from age related damage to the cochlear due to environment and genetic factors [1]
Our study aims to evaluate the cost-effectiveness of unilateral cochlear implants (UCIs) compared to hearing aids and no hearing aids in UK adults with severe to profound hearing loss within a contemporary NHS environment
A UCI for someone that had previously worn a hearing aid in the ear that received the implant led to an average incremental lifetime cost increase of £37,988, and an additional 3.18 QALYs
Summary
Around 11 million people in the UK live with permanent hearing loss, most of which results from age related damage to the cochlear due to environment and genetic factors [1]. A unilateral cochlear implant (UCI) can improve hearing in people with severe to profound sensorineural hearing loss. Improved hearing from using a UCI improves quality of life. Many people in the UK with severe to profound sensorineural hearing loss have missed out on receiving a UCI despite their potential benefits. One study concluded five% of adults eligible for a cochlear implant had received one within the UK, arguing that low provision and utilisation resulted from limited audiological awareness and screening programs [19]. Research suggested that the Bamford–Kowal–Bench (BKB) sentence test was not appropriate for assessing the potential benefits from a cochlear implant for some users, pre-lingual deaf adults, people without English as their native language, and those with low-frequency residual hearing [21]
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