Table 28:
Scenario Analyses
| Scenario | Parameters Used in Reference Case | Parameters Used in Scenario Analysis |
|---|---|---|
| Structure | ||
| Time horizon | Lifetime | 10 years to 30 years |
| Discount | 1.5% costs, 1.5% QALYs | 3% costs, 1.5% QALYs |
| Target Populations | ||
| Adults (20–40 y), sudden severe to profound sensorineural hearing loss (postlingual) | NA | Average age 31,122 simultaneous BCI |
| Adults (18–93 y), severe to profound sensorineural hearing loss (postlingual) | NA | Average age 60,122 sequential BCI, time between implants 3.5 years |
| Adults (18–39 y), severe to profound sensorineural hearing loss (postlingual) | NA | Average age 30,122 sequential BCI, time between implants 3.5 years |
| Adults (40–55 y), severe to profound sensorineural hearing loss (postlingual) | NA | Average age 49,122 sequential BCI, time between implants: 3.5 years |
| Children, severe to profound sensorineural hearing loss (prelingual) | NA | Average age 1 (expert opinion), sequential BCI, time between implants, 1 year |
| Children, sudden severe to profound sensorineural hearing loss (postlingual) | NA | Average age 7,122 simultaneous BCI |
| Reference case 1: BCI type | Sequential | Simultaneous |
| Reference case 2: BCI type | Simultaneous | Sequential |
| Reference case 3: BCI type | Sequential | Simultaneous |
| Clinical Outcomes | ||
| Complications in childhood cochlear implantation | Annual device failure rate 0.64%; annual non-device reimplant rate 0.12% | Annual device failure rate 0.54%;111 annual non-device reimplant rate 0.09%;111 no explantation (expert opinion); all reimplants in same ear (expert opinion) |
| Annual device failure rate | Adults 0.53%; children 0.64% | Cochlear Canada 0.2828%a |
| Ongoing complications | All occur in the first 6 months | All occur in the first 5 years |
| Non-use | Not included | Included 2.2% non-users108b |
| Utilities | ||
| Adults (TTO) | HUI-3 UnoCI 0.495, UUCI 0.765, UBCI 0.800113 |
TTO UnoCI 0.65, UUCI 0.82, UBCI 0.94114 |
| Children (Bond, et al 2007)50 | HUI-3 UnoCI 0.585, UUCI 0.78, UBCI 0.81128,129 |
HUI-3 UBCI = UUCI + 0.0350 |
| Children (Sparreboom et al, 2011)93 | HUI-3 UnoCI 0.585, UUCI 0.78, UBCI 0.81128,129 |
HUI-3 UnoCI 0.395, UUCI 0.58, UBCI 0.7692 |
| Children (adult values) | HUI-3 UnoCI 0.585, UUCI 0.78, UBCI 0.81128,129 |
HUI-3 (adults) UnoCI 0.495, UUCI 0.765, UBCI 0.800113 |
| No utility increase in first 6 months of cochlear implantation | Utility increase applied immediately after cochlear implantation | Utility increase applied 6 months after cochlear implantation |
| Cost and Resource Use | ||
| Perspective | Public health payer perspective | Societal perspective (productivity losses, out-of-pocket costs, costs to other ministries) |
| Use of hearing aids in UCI individuals | No hearing aid costs | Hearing aid costs ($500/5 years, ADP), assuming 80% of patients use119 |
| Postprocedural costs | Table A11 | Based on Fitzpatrick et al, 2006145 (Table A12) |
Abbreviations: ADP, Assistive Devices Program; BCI, bilateral cochlear implantation; HUI-3, health utilities index; NA, not applicable; noCI, no cochlear implantation; QALY, quality-adjusted life-year; TTO, Time Trade Off; U, utility; UCI, unilateral cochlear implantation.
a
Including all models except CI1500, which was removed from the market because of a high failure rate.
b
Assume non-user after year 2 (post-rehabilitation).