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Updated: Dec 9, 2025
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Cost-effectiveness of Pediatric Unilateral/Bilateral Cochlear Implant in a Developing Country
Himanshu Swami1, Arjun Ap1, Shyamal Shivanand2
1Department of ENT and HNS, Command Hospital Air Force, Bangalore, Karnataka.
Insights
Unilateral cochlear implantation (CI) is highly cost-effective for children with profound hearing loss. Bilateral CI also offers significant quality-adjusted life years (QALY) gained within cost-effectiveness thresholds.
Area of Science:
- Otolaryngology
- Health Economics
- Public Health
Background:
- Bilateral profound sensorineural hearing loss (SNHL) significantly impacts children's development.
- Cochlear implantation (CI) is a treatment option, but its cost-effectiveness requires evaluation.
Purpose of the Study:
- To determine the cost-effectiveness of unilateral and bilateral cochlear implantation (CI) for children with bilateral profound SNHL.
- To compare the cost per quality-adjusted life year (QALY) gained between unilateral and bilateral CI.
Main Methods:
- A cost-benefit analysis was conducted in a tertiary-care hospital in a developing country.
- Quality-adjusted life years (QALY) and lifelong expenditures were calculated for 59 patients (29 bilateral CI, 30 unilateral CI).
- Outcomes were compared between groups, and cost per QALY gained was assessed against the country's per capita GDP.
Main Results:
- Significant QALY gains were observed post both unilateral and bilateral CI.
- The net cost per QALY gained was $1,345 for unilateral CI and $1,977 for bilateral CI.
- These costs were below India's per capita GDP ($2,016 in 2018), indicating cost-effectiveness.
Conclusions:
- Unilateral CI is highly cost-effective for children with bilateral profound SNHL.
- Bilateral CI is also cost-effective, with a slightly higher cost per QALY gained but remaining within acceptable thresholds.
Objective:
To determine the cost-effectiveness of unilateral and bilateral cochlear implantation (CI) for children suffering from bilateral profound SNHL.
Study Design:
This was a cost benefit analysis study where quality-adjusted life years (QALY) and the expenditure involved post unilateral and bilateral CI were calculated to assess the cost per QALY gained.
Setting:
The study was conducted in a tertiary-care hospital in a city of a developing country.
Patients:
A total of 59 patients were studied during the years 2015 to 2019 of which a study cohort of 29 patients underwent bilateral cochlear implantation and a control cohort of 30 patients received U/L CI but did not undergo B/L CI.
Main Outcome:
The QALY parameters HUI3 and VAS when patient had no implant, post unilateral and bilateral CI were calculated along with the total lifelong expenditure involved. The outcomes improvement post CI was compared in the study and control groups. The discounted net cost per QALY gained was assessed and compared with the PCGDP of the country for cost effectiveness.
Results:
Significant QALY was gained post unilateral and bilateral CI and the expenditure for both was within the cost thresholds. The net costs per QALY gained post the discounting in unilateral and bilateral CI were found to be 1,345 US$ and 1,977 US$ respectively. The PCGDP (nominal) of India in 2018 was 2,016 US$. The cost involved per QALY gained was found to be lesser than the per capita GDP of India.
Conclusion:
Unilateral CI was found to be highly cost effective with bilateral CI involving a little higher cost per QALY gained but well within the cost effectiveness threshold.
