Table 11:

Results of Economic Literature Review—Summary

				Results
Name, Year, Location	Analytic Technique, Study Design, Perspective, Time Horizon	Population(s)	Interventions, Comparators	Health Outcomes	Costs	Cost-Effectiveness
Monksfield et al, 2011,62 Birmingham, United Kingdom	CUA Piggyback evaluation from uncontrolled before-and-after study UK health care payer perspective Lifetime time horizon	Patients offered a primary bone-anchored hearing aid; likely unilateral implant, although not reported explicitly Tertiary referral, university hospital Mean age = 55 years; Range = NR Male = 39% Indications (type of hearing loss): conductive = 52%; single-sided sensorineural = 44%; mixed = 3%; bilateral sensorineural = 1%	Implant (n = 70): Patients implanted with a primary bone-anchored hearing aid Costs and outcomes were derived from patients after receiving an implant vs. No implant (n = 70): For the counterfactual, patients were assumed to have not received an implant Hearing aid use was assumed to have remained at the same level for the rest of their life expectancy (56% used 1 or 2 standard hearing aids, remaining were unaided) Costs and outcomes were derived from patients prior to implant	Implant: Utility = 0.66 (95% CI 0.60–0.72) No implant: Utility = 0.57 (95% CI 0.51–0.62) for all patients who completed questionnaires before implant Utility = 0.59 (95% CI 0.53–0.65) for patients who completed questionnaires before and after implant Mean difference: 1.89 QALYs (95% CI 0.71–3.23) HUI3 and HUI2 questionnaires completed at baseline (when implant was offered) and 6 months after device fitting QALY = age- and sex-specific life expectancy 1 year after implantation × difference in utility scores before and after Bootstrapped mean QALY gains Discounting 3.5%	Implant: £21,430 (95% CI 20,263–22,535) No implant: £827 (95% CI 644–1,022) Mean difference: £20,604 (95% CI 19,462–21,769) Included costs: assessment, device, surgery, postoperative care, replacement, annual maintenance Bootstrapped mean costs GBP (2008) Discounting 3.5%	Authors concluded bone-anchored hearing aids can be cost-effective Base case analysis: ICER = £17,610 per QALY using HUI3 ICER = £21,688 per QALY using HUI2 Probabilistic sensitivity analysis (WTP = £20,000 per QALY): Probability of being cost-effective = 56% Sensitivity analyses were conducted by varying discount rates (no discounting, discounting costs only). Results did not change qualitatively

Abbreviations: CI, confidence interval; CUA, cost–utility analysis; HUI2, Health Utilities Index Mark II questionnaire; HUI3, Health Utilities Index Mark III questionnaire; ICER, incremental cost-effectiveness ratio; NR, not reported; QALY, quality-adjusted life-year; WTP, willingness-to-pay.