TY - JOUR
T1 - Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults
T2 - A Randomized Controlled Trial
AU - Smulders, Yvette E
AU - van Zon, Alice
AU - Stegeman, Inge
AU - van Zanten, Gijsbert A
AU - Rinia, Albert B
AU - Stokroos, Robert J
AU - Free, Rolien H
AU - Maat, Bert
AU - Frijns, Johan H M
AU - Mylanus, Emmanuel A M
AU - Huinck, Wendy J
AU - Topsakal, Vedat
AU - Grolman, Wilko
PY - 2016/1
Y1 - 2016/1
N2 - OBJECTIVE: To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI.STUDY DESIGN: Randomized controlled trial (RCT).SETTING: Five tertiary referral centers.PATIENTS: Thirty-eight postlingually deafened adults eligible for cochlear implantation.INTERVENTIONS: A cost-utility analysis was performed from a health insurance perspective.MAIN OUTCOME MEASURES: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy.RESULTS: Direct costs for unilateral and bilateral CI were &OV0556;43,883 ± &OV0556;11,513(SD) and &OV0556;87,765 ± &OV0556;23,027(SD) respectively. Annual costs from the second year onward were &OV0556;3,435 ± &OV0556;1,085(SD) and &OV0556;6,871 ± &OV0556;2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing.CONCLUSION: This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.
AB - OBJECTIVE: To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI.STUDY DESIGN: Randomized controlled trial (RCT).SETTING: Five tertiary referral centers.PATIENTS: Thirty-eight postlingually deafened adults eligible for cochlear implantation.INTERVENTIONS: A cost-utility analysis was performed from a health insurance perspective.MAIN OUTCOME MEASURES: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy.RESULTS: Direct costs for unilateral and bilateral CI were &OV0556;43,883 ± &OV0556;11,513(SD) and &OV0556;87,765 ± &OV0556;23,027(SD) respectively. Annual costs from the second year onward were &OV0556;3,435 ± &OV0556;1,085(SD) and &OV0556;6,871 ± &OV0556;2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing.CONCLUSION: This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.
KW - Bilateral cochlear implantation
KW - Cochlear implant
KW - Cost-effectiveness
KW - Cost-utility
KW - Deafness
KW - Hearing loss
UR - http://www.scopus.com/inward/record.url?scp=84952715177&partnerID=8YFLogxK
U2 - 10.1097/MAO.0000000000000901
DO - 10.1097/MAO.0000000000000901
M3 - Article
C2 - 26649604
SN - 1531-7129
VL - 37
SP - 38
EP - 45
JO - Otology & Neurotology
JF - Otology & Neurotology
IS - 1
ER -