COST-EFFECTIVENESS OF CI RELATIVE TO OTHER MEDICAL DEVICES
Cochlear Implantation (CI) is more cost-effective when compared with hearing aids (HAs) and other non-implantable treatments for hearing loss (Bond et al, 2009). From the health care perspective, CI is also more cost-effective when compared with other high cost implantable medical devices, such as pacemakers and implantable cardiac defibrillators. The cost-effectiveness ratios defined as ‘Cost per Quality Adjusted Life Year (QALY) gained’ for these interventions are shown
in Figure 1 - devices are listed from top to bottom in the order of most cost-effective to least cost-effective. Recent reports also suggest that earlier implantation leads to an improvement in the cost-effectiveness of CI, and unilateral or bilateral implantation is more cost-effective compared with no intervention in children and adults.
Cochlear implantation is cost-effective when compared with other treatments.
COST-EFFECTIVENESS OF IMPLANTATION IS RELATED TO AGE AT IMPLANTATION
CI was more cost-effective in children implanted at age <18 months compared with children implanted at age 18-36 months, and age >36 months respectively (Semenov et al, 2013). Earlier implantation minimises language delays, allowing age- equivalent language development. This translates into related benefits such as higher educational placement, enhanced employment opportunities and productivity (Summerfield and Marshall 1999). CI was cost-saving in children when net savings from education expenses were considered (Schuleze-Gattermann et al, 2002; and Semenov et al, 2013). The total lifetime education cost savings from CI in children ranged from USD $167,000 to $191,000 (Semenov et al 2013).
The cost -effectiveness of CI improved with an earlier age at implantation, and was shown to be cost saving when education costs were included.
COST-EFFECTIVENESS OF UNILATERAL CI VERSUS NO INTERVENTION
The cost-effectiveness of unilateral CI is illustrated in Figure 2. A comprehensive National Institute of Health and Care Excellence (NICE) health technology assessment (HTA) showed that unilateral CI compared with no intervention was cost- effective in both children and adults (Bond et al, 2009). Chen et al (2014) showed that unilateral CI was cost-effective in adults when compared with HAs or no intervention in the Canadian context. Francis et al (2002) showed unilateral CI in adults aged >50 years to be cost-effective in the US healthcare system. Lee et al (2006) demonstrated the cost-effectiveness of unilateral CI in adults in Korea. These studies used the Health Utility Index (HUI) for measuring health-related QALY.
By contrast, Summerfield et al 2010 used the time-trade off (TTO) method and Visual Analogue Scale (VAS).
Cochlear Implantation was cost-effective when compared with HAs or no intervention.
COST-EFFECTIVENESS OF BILATERAL CI AND UNILATERAL CI COMPARED WITH HAs
The cost effectiveness of unilateral CI compared with no intervention or HAs is well-established. To date, a large number of small studies, generally using patients as their own controls, demonstrated that bilateral CI significantly improved speech perception in noise and sound localisation, in children and adults (Bond et al, 2009). The NICE review in 2009 recommended the provision of simultaneous bilateral CI to children born deaf, adventitiously deaf or those newly diagnosed with severe-to-profound bilateral hearing impairment (Bond et al, 2009). Similar recommendations have been made by the Medicaid Scheme of Washington State of the United States more recently (Washington State Health Care Authority Review, 2013).
Cochlear Ltd, Economics of Cochlear Implantation, February 2015