The effect of different utility measures on the cost‐effectiveness of bilateral cochlear implantation

Abstract

Objectives/Hypothesis: To determine if the choice of health utility measure affects the incremental cost-utility ratio (ICUR) when assessing the cost-effectiveness of bilateral cochlear implantation (CI).Study Design: A scenario-based estimate with three scenarios: 1) a patient with severe to profound sensorineural hearing loss with no intervention, 2) the same patient with a unilateral CI with average or better performance, and 3) the same patient with bilateral CIs with average or better performance.Methods: One hundred and forty-two subjects comprising preimplantees (n 5 30), unilateral cochlear implantees (n 5 30), bilateral implantees (n 5 30), and healthcare professionals (n 5 52). The four health utility instruments applied were the Health Utility Index Mark 3 (HUI3), European Quality of Life Questionnaire in 5 Domains (EQ5D), visual analog scale (VAS), and time trade-off (TTO). Cost for each implant was based on a 25-year time horizon, 50% discount for the second implant, and a 15% failure rate.Results: Using the HUI3, the utility gain from unilateral to bilateral implantation was 0.035 or 11.5% of the total utility gain. This ratio was higher using the other instruments: EQ5D (22.2%), VAS (35.0%), and TTO (41.4%). For the scenario of bilateral CI compared to no intervention, HUI3 ICUR estimates were the lowest, and for bilateral CI compared to unilateral CI, HUI3 ICUR estimates were the highest.Conclusions: The choice of utility instrument in cost-utility analysis of bilateral CI heavily influences whether the second implant is deemed cost-effective. The HUI3 is the utility of choice in CI studies and is the most conservative.

Quality of Life and Cost-Effectiveness of Cochlear Implants: A Narrative Review

“…We noted consistency across studies using the various instruments; however, the HUI3 is generally regarded as the most conservative and consistent measure of HRQoL for studies of CI cost utility [Kuthubutheen et al, 2015]. In most studies, the HUI3 does not show significant gain in utility from the unilateral to bilateral CI condition though it was reported clearly sensitive to unilateral CI.…”

“…It scores in 8 dimensions, including vision, speech, hearing, ambulation, dexterity, emotion, cognition, and pain. Although a generic instrument, it does include an assessment of the impact of sensory impairments [Kuthubutheen et al, 2015]. The EQ5D and associated VAS are described above.…”

The Advances in Hearing Rehabilitation and Cochlear Implants in China

“…Bilateral CI has been shown to be cost-effective when compared to no intervention, although most of the gains are made by the first implant (Chen et al, 2014). The cost-untility of bilateral CI when compared to unilateral CI varies depending on the analysis performed (Kuthubutheen et al, 2015). Currently, bilateral CI is widely accepted as a safe and effective means of bilateral auditory stimulation in China.…”

Variables that Effect Psychophysical Parameters and Duration to Stability in Cochlear Implant Mapping

“…Bilateral implantation have added benefits (over unilateral) to recipients with bilateral profound hearing loss including improved sound localization and speech perception in noise [28,29]. This follows on to provide improved quality of life in a way that can be measured as a positive over the economic cost [10][11][12][13]. A randomized control trial on cost utility of bilateral implants concluded that bilateral implants is cost effective if the patient has a life expectancy of five to ten years or longer [30].…”

“…Patient audiological benefits are often balanced with the costs associated with cochlear implantation to justify the health economics, many such analyses take into account the direct and indirect surgical and device costs but do not directly evaluate the costs associated with rehabilitation afterwards [10][11][12][13].…”