Impact of Expanding Eligibility Criteria for Cochlear Implantation - Dynamic Modeling Study

Area of Science:

• Otolaryngology and Health Economics
• Audiology and Medical Technology Assessment

Background:

• Cochlear implantation (CI) eligibility criteria are evolving with technological advancements.
• Current criteria primarily focus on profound hearing loss (HL).

Purpose of the Study:

• To evaluate the impact of expanding unilateral CI criteria to include severe HL (61-80 dBHL).
• To assess changes in recipient numbers, costs, quality of life, and cost-effectiveness.

Main Methods:

• A dynamic population-based Markov model simulating the Dutch population over 20 years.
• Inclusion of health states: severe HL, profound HL, CI recipients, and non-recipients.
• Model parameters derived from literature, national databases, expert opinion, and calibration.

Main Results:

• Expanding CI eligibility to severe HL could increase recipients 6-7 times, with associated costs of €550 million and 54,000 QALYs gained.
• The incremental cost-utility ratio was estimated at €10,771 per QALY.
• Sensitivity analysis highlighted employment, CI utility, and surgical costs as key factors.

Conclusions:

• Expanding CI eligibility to severe HL may represent a cost-effective allocation of healthcare resources.
• Significant expansion of diagnostic, operative, and rehabilitative services would be required.
• Quantitative estimates provide a basis for societal discussion on pursuing this expansion.