Yvette E Smulders1, Alice van Zon, Inge Stegeman, Gijsbert A van Zanten, Albert B Rinia, Robert J Stokroos, Rolien H Free, Bert Maat, Johan H M Frijns, Emmanuel A M Mylanus, Wendy J Huinck, Vedat Topsakal, Wilko Grolman. 1. *Department of Otorhinolaryngology, Head and Neck Surgery†Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht‡Department of Otorhinolaryngology, Isalaklinieken, Zwolle§Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht||Department of Otorhinolaryngology¶Graduate School of Medical Sciences, Research School of Behavioral and Cognitive Neurosciences, University Medical Center Groningen, Groningen#Department of Otorhinolaryngology, Head and Neck Surgery**Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden††Department of Otorhinolaryngology, Head and Neck Surgery‡‡Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
OBJECTIVE: To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. STUDY DESIGN: Randomized controlled trial (RCT). SETTING:Five tertiary referral centers. PATIENTS: Thirty-eight postlingually deafened adults eligible for cochlear implantation. INTERVENTIONS: A cost-utility analysis was performed from a health insurance perspective. MAIN OUTCOME MEASURES: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy. RESULTS: Direct costs for unilateral and bilateral CI were €43,883 ± €11,513(SD) and €87,765 ± €23,027(SD) respectively. Annual costs from the second year onward were €3,435 ± €1,085(SD) and €6,871 ± €2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing. CONCLUSION: This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.
RCT Entities:
OBJECTIVE: To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. STUDY DESIGN: Randomized controlled trial (RCT). SETTING: Five tertiary referral centers. PATIENTS: Thirty-eight postlingually deafened adults eligible for cochlear implantation. INTERVENTIONS: A cost-utility analysis was performed from a health insurance perspective. MAIN OUTCOME MEASURES: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy. RESULTS: Direct costs for unilateral and bilateral CI were €43,883 ± €11,513(SD) and €87,765 ± €23,027(SD) respectively. Annual costs from the second year onward were €3,435 ± €1,085(SD) and €6,871 ± €2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing. CONCLUSION: This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.
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