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Cynthia S. Palmer, MS; John K. Niparko, MD; J. Robert Wyatt, MD; Margaret Rothman, PhD; Gregory de Lissovoy, PhD

Arch Otolaryngol Head Neck Surg. 1999;125:1221-1228.

Context  Prior clinical studies have indicated that cochlear implantation provides benefits to individuals with advanced sensorineural hearing loss who are unable to gain effective speech recognition with hearing aids.

Objective  To determine the cost per quality-adjusted life-year (QALY) for adults receiving multichannel cochlear implants.

Design  Prospective 12-month multicenter study using preference-based quality-of-life measures and total cost determinations, comparing profoundly hearing-impaired adult subjects with and without cochlear implants.

Setting  Hospital-based and patient-resource clinics.

Patients  Severely to profoundly hearing-impaired adult recipients of a cochlear implant and adults eligible for the device who had not yet received it.

Main Outcome Measure  Clinical assessment of implant participants included medical and audiologic (speech understanding) data at the time of enrollment, 6 months, and 12 months. All participants' health-utility was assessed at the time of enrollment, 6 months, and 12 months using the Health Utility Index. One-year medical resource utilization and cost data included bills related to implants, patient diaries, charge estimates from clinical sites, and published literature. A decision model was developed to determine cost per QALY.

Results  Of the 84 enrolled adults, 62 (75%) completed the study. Mean health-utility scores at the time of enrollment were identical between groups. The marginal 12-month health-utility gain for implant recipients was 0.20; 90% of this improvement was achieved within 6 months. For patients with a mean 22-year life expectancy, the marginal cost per QALY was $14,670.

Conclusions  Overall, multichannel cochlear implants significantly improved recipients' performance on measures of speech understanding and ratings of health-utility within 6 months of implantation. The multichannel cochlear implant yielded a very favorable cost per QALY.

From MEDTAP International, Bethesda, Md (Ms Palmer and Dr de Lissovoy); the Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Niparko and Wyatt); and Battelle Center for Public Health Research and Evaluation, Arlington, Va (Dr Rothman). Dr Rothman is currently with Janssen Pharmaceutica, Titusville, NJ.

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