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A cost-utility scenario analysis of bilateral cochlear implantation
A Quentin Summerfield1, David H Marshall, Garry R Barton
1Medical Research Council Institute of Hearing Research, University Park, Nottingham, England. aqs@ihr.mrc.ac.uk
Context:
Unilateral cochlear implantation is a cost-effective intervention for profound bilateral hearing loss. There is worldwide interest in providing implants bilaterally.
Objective:
To use modeling to estimate the cost of gaining a quality-adjusted life-year by providing implants to both ears of profoundly postlingually deafened adults.
Design:
Economic scenario analysis relating the costs of providing implants to estimates of the gain in health-related quality of life (utility) from unilateral and bilateral implantation.
Setting:
Fourteen hospitals in the United Kingdom National Health Service and 1 Medical Research Council research unit.
Participants:
Normal-hearing adult volunteers with knowledge of implantation (n = 70). Adults undergoing unilateral implantation who either did not benefit from acoustic hearing aids preoperatively (type 1, n = 87) or benefited marginally (type 2, n = 115).
Main Outcome Measures:
Changes in utility from unilateral and bilateral implantation estimated with the time trade-off technique (volunteers) and from unilateral implantation measured with the Mark II Health Utilities Index (patients); costs of providing implants and sustaining patients who have undergone implantation (health care perspective).
Results:
Gains in utility from unilateral implantation estimated by volunteers did not differ significantly from gains recorded by patients, giving credibility to the volunteers' estimate of the gain from bilateral compared with unilateral implantation. Cost-utility ratios, in pounds sterling per quality-adjusted life-year, based on volunteers' estimates, were pound 16,774 (type 1: unilateral implantation vs no intervention), pound 27,401 (type 2: unilateral implantation vs management with hearing aids), pound 61,734 (simultaneous bilateral implantation vs unilateral implantation), and pound 68,916 (provision of an additional implant vs no additional intervention).
Conclusion:
More quality of life is likely to be gained per unit of expenditure on unilateral implantation than bilateral implantation.