Table 29:
Sensitivity Analyses and Scenario Analyses, Primary Economic Evaluation
| Scenario | Parameter(s) Used in Reference Case | Parameter(s) Used in Scenario Analysis |
|---|---|---|
| Age of implantation (all models) | Mean age (Table 12) | Lower and upper range (Table 12) |
| Time horizon (all models) | 25 years for cochlear implants; 10 years for bone-conduction devices | Lifetime |
| Perspective (all models) | Ministry of Health | Public payer (includes Ministry Health, Ministry of Community and Social Services, Ministry of Child and Youth Services, Ministry of Education); additional costs include sound processor replacement for people with low income, and rehabilitation for children with cochlear implants |
| Complication rates (models 2 and 3) | Rates associated with:
|
Rates associated with other types of bone-conduction implants (Appendix 7, Table A8) |
| Risk of minor complications (all models) Device non-use (all models) | Minor complications occur in first year of implantation As described in Table 15, Table 17, Appendix Table A9, and Appendix Table A10 | All models: minor complications occur over entire duration of model As described in Table 15, Table 17, Appendix Table A9, and Appendix Table A10; includes time-dependent data from the literature |
| Risk of non-use (all models) | Non-use occurs over duration of follow-up data from Ontario Cochlear Implant Program (4 m to 5 y) | Non-use occurs over entire duration of model |
| Mortality (all models) | Background mortality only | Increased risk of mortality associated with hearing loss in elderly ≥ 70 years (HR = 1.39; 95% CI = 0.97 to 2.01) |
| Health utilities (models 2 and 3) | HUI3 data from Ontario hospital based on active transcutaneous bone-conduction implants | Utilities from systematic search; based on other bone-conduction implants |
| Disutilities (all models) | No disutilities applied to complications | Applied disutilities to complications |
| Rehabilitation costs (model 1) | Community-based rehabilitation (every week for 18 months) for children; none for adults | Same as reference case for children; hospital-based rehabilitation (2 to 3 1-hour sessions) for adults |
| Sound processor (all models) | Assistive Devices Program pays up to a maximum amount for replacement sound processors | Assistive Devices Program pays the full amount for replacement sound processors |
| Discount rate (all models) | 1.5% | 0%, 3%, 5% |
Abbreviations: CI, confidence interval; EQ-5D VAS, EuroQol 5 Dimensions questionnaire visual analogue scale; HR, hazard ratio; HUI3, Health Utilities Index Mark III questionnaire; m, month; TTO, time trade-off; y, year.