Direct costs of unilateral cochlear implantation in people over 60 years

Unilateral cochlear implantation (CI) is the recommended treatment for profound sensorineural hearing loss in older adults when hearing aids fail to provide benefit. This study aimed to determine the direct costs associated with this procedure to support health-care provider decision-making.

A cross-sectional observational study was performed at a single-centertertiary hospital on 278 cochlear implant recipients aged 60 years or older between 2009 and 2020. A final sample of 71 subjects (37 women, 52.1%) was selected via stratified random sampling. A micro-costing (bottom-up) economic analysis was conducted. Direct costs were allocated according to the Framework Agreement and the Andalusian Health Service salary tables, including the device, allowances, personnel, surgery, hospitalisation, clinical follow-up, complications, and technology upgrades. Costs were updated to 2024 ; and calculated over a mean time horizon of 23.3 years.

The mean age at CI was 67.7 ± 5.8 years. Complications occurred in 8.4% of patients, incorporating the costs of one explantation/reimplantation. The mean total cost per patient was ; 44,555.08. Device acquisition and processor upgrades represented the largest share (93.58%, ; 41,696), while personnel accounted for 6.41% (; 2,859.08) and complications for 0.67% (; 297).

The direct costs of a unilateral CI procedure in individuals over 60 amount to an investment of ; 44,555.08, driven primarily by device and processor upgrade expenses. Personnel costs are low but involve substantial multiprofessional organisational complexity. Deriving direct costs from primary sources tied to a specific clinical pathway provides a more realistic estimate than probabilistic modelling and can aid health-care administrations in decision-making.