Cost-effective analysis of unilateral cochlear implantation under the Taiwan national healthcare insurance
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Updated: Jan 19, 2026
Cochlear Implantation in the Guinea Pig
Published on: June 15, 2018
Te-Yung Fang1,2, Li-Jen Cheng3, David Bin-Chia Wu4,5
1Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan, ROC.
Insights
Cochlear implantation (CI) is cost-effective for deaf children in Taiwan. Unilateral CI with a hearing aid (UCI-HA) offers significant value within the national health insurance program, providing a favorable incremental cost-effectiveness ratio.
Area of Science:
- Health Economics
- Otolaryngology
- Public Health
Background:
- The cost-effectiveness of cochlear implantation (CI) in Taiwan remains unestablished.
- Evaluating paediatric CI is crucial for healthcare policy within Taiwan's National Health Insurance (NHI) program.
Purpose of the Study:
- To assess the cost-effectiveness of paediatric unilateral cochlear implantation (UCI) with a contralateral acoustic hearing aid (UCI-HA) compared to bilateral hearing aids (HA).
- To analyze the economic value of CI within Taiwan's NHI framework.
Main Methods:
- A Markov model-based cost-utility analysis (CUA) was employed.
- One-way sensitivity analyses identified key cost drivers for the incremental cost-effectiveness ratio (ICER).
- Monte Carlo simulations assessed the impact of parameter uncertainty on cost-effectiveness.
Main Results:
- The UCI-HA strategy yielded an ICER of $6487 per quality-adjusted life year (QALY) gained compared to bilateral HAs.
- ICERs remained below $7000/QALY and were most sensitive to the external CI device's selling price.
- UCI-HA demonstrates over 50% probability of cost-effectiveness if the threshold exceeds $10,000/QALY.
Conclusions:
- Unilateral cochlear implantation (UCI) is a highly cost-effective intervention for deaf children in Taiwan.
- The findings support the integration of UCI into Taiwan's NHI program for pediatric hearing loss management.
Abstract:
Objective: The value of cochlear implantation (CI) has not been established in Taiwan. The purpose of this study was to evaluate the cost-effectiveness of paediatric CI within the context of Taiwan's national health insurance (NHI) programme.Design: A Markov model-based cost-utility analysis (CUA) was conducted to evaluate the cost-effectiveness of a unilateral CI (UCI) with a contralateral acoustic hearing aid (UCI-HA) compared with a bilateral HA. We performed one-way sensitivity analyses to identify the cost variables that affected the incremental cost-effectiveness ratio (ICER) the most. Monte Carlo simulation was used to explore the simultaneous effect of all uncertain parameters on cost-effectiveness.Study sample: Not applicable.Results: Compared with bilateral HAs, the ICER for UCI-HA was $6487 per quality-adjusted life year (QALY) gained. The ICERs were consistently below $7000 per QALY gained and were most sensitive to the selling price of the external CI device. When this selling price increased by 10%, the ICER of UCI-HA would increase to $6954 per QALY gained. UCI-HA has a probability greater than 50% of being cost-effective if the cost-effectiveness threshold exceeds approximately $10,000 per QALY.Conclusions: Our analysis suggested that within the context of Taiwan's NHI programme, UCI is highly cost-effective for deaf children.
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