Abstract
BackgroundResearch has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults. However, only 13% of eligible Swedish adults currently use a unilateral CI. The objective was to estimate the cost-effectiveness of unilateral CIs compared to a hearing aid for Swedish adults with severe to profound hearing loss.MethodsA Markov model with a lifetime horizon and six-month cycle length was developed to estimate the benefits and costs of unilateral CIs from the Swedish health system perspective. A treatment pathway was developed through consultation with clinical experts to estimate resource use and costs. Unit costs were derived from the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions. Health outcomes were reported in terms of Quality Adjusted Life Years (QALYs).ResultsUnilateral CIs for Swedish adults with severe to profound hearing loss are likely to be deemed cost-effective when compared to a hearing aid (SEK 140,474 per QALY gained). The results were most sensitive to the age when patients are implanted with a CI and the proportion of patients eligible for CIs after triage.ConclusionsAn increase in the prevalence of Swedish adults with severe to profound hearing loss is expected as the population ages. Earlier implantation of unilateral CIs improves the cost-effectiveness among people eligible for CIs. Unilateral CIs are an efficacious and cost-effective option to improve hearing and quality of life in Swedish adults with severe to profound hearing loss.
Highlights
Research has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults
Scenario analysis Patient age It was estimated that lowering the patient age from 61 to 50 years in the model reduced the Incremental Cost-Effectiveness Ratio (ICER) associated with a unilateral CI to SEK 118,232 per Quality Adjusted Life Years (QALYs) gained (Table 4)
Proportion eligible after triage It was estimated that increasing the proportion of patients eligible after triage from 56% to 70% reduced the ICER associated with a unilateral CI to SEK 136,964 per QALY gained (Table 4)
Summary
Research has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults. Only 13% of eligible Swedish adults currently use a unilateral CI. The objective was to estimate the cost-effectiveness of unilateral CIs compared to a hearing aid for Swedish adults with severe to profound hearing loss. The World Health Organisation estimates that 466 million people worldwide have disabling hearing loss of which 93% are adults and 7 % are children [1]. The number of people with hearing loss in developed countries is set to increase due to population ageing. In Sweden it is estimated that approximately 0.2% of the adult population, or 20,000 people, have severe to profound hearing loss [2]. Hearing loss can reduce a person’s ability to communicate and be socially engaged. CIs improve quality of life regardless of patients’ age [14] and can improve the quality of life of family members [13]
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