Table 17:
Results of Economic Literature Review—Summary
| Results | |||||||
|---|---|---|---|---|---|---|---|
| Name, Year, Location | Analytic Technique, Study Design, Perspective, Time Horizon | Population(s) | Intervention/Comparator(s) | Quality of Life Measurea | Health Outcomes | Costs | Cost-Effectiveness |
| Bichey et al, 2008,115 United States | CUA Pre/post studyb (n = 23) Public health payer perspectivec Lifetime horizon |
Adults and children (age 6–79), postlingually deaf, severe to profound bilateral hearing loss | BCI (sequential)/UCI BCI (sequential)/no intervention |
HUI-3, measured directly in target population (n = 23); measured before cochlear implantation, with UCl, and with BCI | Group means not reported | Group means not reported |
ICER (USD, 5% discount) BCI vs. UCI: $2,187/QALYd BCI vs. no intervention: $23,345/QALYd |
| Bond et al, 2009,50 United Kingdom | CUA Markov cohort model Public health payer perspective Lifetime horizon |
Adults (age 50), postlingually deaf, profound hearing loss Children (mean age 1), prelingually deaf, profound hearing loss |
BCI (sequential)/UCI BCI (simultaneous)/UCI |
HUI-3, obtained from literature |
QALYs (3.5% discount) Adults BCI (sequential): 10.93 BCI (simultaneous): 10.99 UCI: 10.60 Children BCI (sequential): 16.45 BCI (simultaneous): 16.51 UCI: 15.84 |
Cost (GBP, 3.5% discount) Adults BCI (sequential): £53,866 BCI (simultaneous): £53,255 UCI: £34,207 Children BCI (sequential): £93,098 BCI (simultaneous): £87,546 UCI: £60,441 |
ICER (GBP, 3.5% discount) Adults BCI (sequential) vs. UCI: £60,301/QALY BCI (simultaneous) vs. UCI: £49,559/QALY Children BCI (sequential) vs. UCI: £54,098/QALY BCI (simultaneous) vs. UCI: £40,410/QALY |
| Chen et al, 2014113; Kuthubutheen et al, 2015,114 Ontario, Canada | CUA Decision analysis Public health payer perspective 25-year time horizon |
Adults, severe to profound hearing loss, no benefit from hearing aids | BCI (sequential)/UCI BCI (sequential)/ no intervention |
HUI-3, EQ-5D, VAS and TTO, measured indirectly in postlingually deafened adults with severe to profound hearing loss who met criteria for cochlear implantation (n = 30); postlingually deafened adults with at least 1 year of UCI experience (n = 30); postlingually deafened adults with at least 1 year of BCI experience (n = 30); experts (audiologists, surgeons, researchers, therapists; n = 52) |
QALYs (HUI-3; EQ-5D; VAS; TTO) BCI: 20.00; 23.24; 22.00; 23.50 UCI: 19.12; 22.25; 20.25; 20.50 No intervention: 12.38; 18.75; 17.00; 16.25 |
Cost (USD) BCI: $111,764 UCI: $63,622 No intervention: $0 |
ICER (USD: HUI-3; EQ-5D; VAS; TTO)e BCI vs. UCI: $55,020/QALY; $48,142/QALY; $27,510/QALY; $16,047/QALY BCI vs. no intervention: $14,658/QALY; $24,837/QALY; $22,353/QALY; $15,416/QALY |
| Perez-Martin et al, 2017,116 Spain | CUA Markov cohort model Public health payer perspective Lifetime horizon |
Children (age 1), prelingually deaf, severe to profound hearing loss | BCI (simultaneous)/UCI BCI (sequential)/ UCI |
TTO, obtained from literature | Group means not reported | Group means not reported |
ICER (EUR, 3% discount) BCI (simultaneous) vs. UCI: €10,323/QALY BCI (sequential) vs. UCI: €11,733/QALY |
| Smulders et al, 2016,117 Netherlands | CUA RCT (n = 38) Private health payer perspective Lifetime horizon |
Adults (age 18–70), postlingually deaf, severe to profound hearing loss, ability to hear (with hearing aids) until 10 years ago, marginal hearing aid benefit | BCI (simultaneous)/ UCI |
HUI-3, EQ-5D, TTO, VAS, measured directly in target population randomized to BCI (n = 19) or UCI (n = 19) |
Mean 1-year postoperative utility (HUI-3; EQ-5D; TTO; VAS) BCI: 0.71; 0.90; 0.99; 0.75 UCI: 0.68; 0.93; 0.91; 0.79 Mean 2-year postoperative utility (HUI-3; EQ-5D; TTO; VAS) BCI: 0.72; 0.92; 0.99; 0.78 UCI: 0.68; 0.94; 0.90; 0.80 |
Costs (EUR, 0% discount) BCI: €95,290 UCI: €47,972 |
ICER (EUR, 0% discount) BCI reported as cost-effective vs. UCI using HUI-3 and TTO, but not cost-effective using EQ-5D or VAS |
| Summerfield et al, 2002,118 United Kingdom | CUA Decision analysisf Public health payer perspective 30-year time horizon |
Adults, postlingually deaf, profound hearing loss | BCI (simultaneous)/UCI BCI (sequential)/UCI BCI (simultaneous)/hearing aidsg BCI (simultaneous)/no intervention |
TTO measured indirectly in volunteers, including clinicians and staff (n = 70) | Group means not reported | Group means not reported |
ICER (GBP, 6% discount) BCI (simultaneous) vs. UCI: £61,734/QALY BCI (sequential) vs. UCI: £68,916/QALY BCI (simultaneous) vs. hearing aidsg: £35,002/QALY BCI (simultaneous) vs. no intervention: £23,578/QALY |
| Summerfield et al, 2010,119 United Kingdom | CUA Markov modelf Public health payer perspective Lifetime horizon |
Children (age 1), prelingually deaf, severe to profound hearing loss | BCI (simultaneoush)/UCI |
TTO/VAS measured indirectly in clinicians, researchers, undergraduate students, members of the public (n = 180) | Group means not reported | Group means not reported |
ICER (GBP, 3.5% discount, TTO; VAS) BCI vs. UCI: £21,656/QALY; £18,182/QALY |
Abbreviations: BCI, bilateral cochlear implant; CUA, cost-utility analysis; EQ-5D, EuroQoL quality of life questionnaire; HUI-3, Health Utilities Index–3; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; RCT, randomized, controlled trial; TTO, Time Trade Off; UCI, unilateral cochlear implant; VAS, visual analog scale.
a
Included if study directly measured quality of life.
b
Case control study stated, but appeared to be a pre/post design.
c
Societal perspective stated, but appeared to be public health payer perspective.
d
Unclear how value was calculated; two individuals excluded from analysis.
e
ICER did not vary for discount rates.
f
Study design unclear.
g
Marginal hearing aid users.
h
Not explicit in text; we assumed they referred to simultaneous implantation.