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A Cost-Utility Scenario Analysis of Bilateral Cochlear Implantation
A. Quentin Summerfield, PhD;
David H. Marshall, PhD;
Garry R. Barton, MSc;
Karen E. Bloor, MSc
Arch Otolaryngol Head Neck Surg. 2002;128:1255-1262.
Context Unilateral cochlear implantation is a cost-effective intervention for profound bilateral hearing loss. There is worldwide interest in providing implants bilaterally.
Objective To use modeling to estimate the cost of gaining a quality-adjusted life-year by providing implants to both ears of profoundly postlingually deafened adults.
Design Economic scenario analysis relating the costs of providing implants to estimates of the gain in health-related quality of life (utility) from unilateral and bilateral implantation.
Setting Fourteen hospitals in the United Kingdom National Health Service and 1 Medical Research Council research unit.
Participants Normal-hearing adult volunteers with knowledge of implantation (n = 70). Adults undergoing unilateral implantation who either did not benefit from acoustic hearing aids preoperatively (type 1, n = 87) or benefited marginally (type 2, n = 115).
Main Outcome Measures Changes in utility from unilateral and bilateral implantation estimated with the time trade-off technique (volunteers) and from unilateral implantation measured with the Mark II Health Utilities Index (patients); costs of providing implants and sustaining patients who have undergone implantation (health care perspective).
Results Gains in utility from unilateral implantation estimated by volunteers did not differ significantly from gains recorded by patients, giving credibility to the volunteers' estimate of the gain from bilateral compared with unilateral implantation. Cost-utility ratios, in pounds sterling per quality-adjusted life-year, based on volunteers' estimates, were £16 774 (type 1: unilateral implantation vs no intervention), £27 401 (type 2: unilateral implantation vs management with hearing aids), £61 734 (simultaneous bilateral implantation vs unilateral implantation), and £68 916 (provision of an additional implant vs no additional intervention).
Conclusion More quality of life is likely to be gained per unit of expenditure on unilateral implantation than bilateral implantation.
From the Medical Research Council Institute of Hearing Research, University Park, Nottingham, England (Drs Summerfield and Marshall); and Department of Health Sciences and Clinical Evaluation, University of York, York, England (Mr Barton and Ms Bloor).
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