Affiliation:
1. Department of Otorhinolaryngology of the Virgen Macarena University Hospital
2. Department of Nursing University of Seville
3. Andalusian School of Public Health
4. Department of Otorhinolaryngology of the Virgen Macarena University Hospital, University of Seville, Seville, Spain
Abstract
Objective
To determine the cost-effectiveness or cost-utility of cochlear implants (CI) in adults with severe to profound bilateral hearing loss.
Databases Reviewed
PubMed (Medline), The Cochrane Library, Embase via Elsevier, EBSCOhost CINAHL, and Scopus.
Methods
The study included adult participants with severe to profound bilateral neurosensory hearing loss. The analysis encompassed quality of life improvements, costs, cost-effectiveness, cost-utility, cost-benefit, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Systematic reviews, meta-analyses, case series, and prospective or retrospective cohort studies published in English between 2010 and 2023 were retrieved. Exclusion criteria included incomplete studies, abstracts, clinical cases, editorials, letters, studies involving pediatric populations, single-side deafness, methodology research, noneconomic aspects of CI, mixed child and adult data, and studies published before 2010. The risk of bias was assessed following the criteria outlined in Appendix I of the economic evaluation's quality assessment as per the NICE Guideline Development Method.
Results
Ten articles met the criteria and were included in the qualitative synthesis. One study conducted a prospective cost-utility analyses, one carried out a cost-benefit analyses, one was a randomized controlled clinical trial focusing on cost-utility, and another was a clinical trial addressing cost-effectiveness. Six studies employed Markov models, and one study utilized uniquely the Monte Carlo method. None quantified the economic impact of improved hearing on cognitive function.
Conclusions
The heterogeneity of sources impacted data quality. Unilateral and sequential bilateral CI appeared to be cost-effective when compared with bilateral hearing aids or nontechnological support. When properly indicated, simultaneous bilateral CIs are cost-effective compared to no interventions and to unilateral cochlear implantation through differential discounting or variations from the base cases, especially with a life expectancy of 5–10 years or longer.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Reference27 articles.
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2. Summary health statistics for U.S. adults: national health interview survey, 2012;Vital Health Stat 10,2014
3. Prevalence of age-related hearing loss in Europe: a review;Eur Arch Otorhinolaryngol,2011
4. Association of hearing aids and cochlear implants with cognitive decline and dementia: a systematic review and Meta-analysis;JAMA Neurol,2023
5. U.S. population data on hearing loss, trouble hearing, and hearing-device use in adults: National Health and Nutrition Examination Survey, 2011–12, 2015–16, and 2017–20;Trends Hear,2023