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Age Dependent Cost-Effectiveness of Cochlear Implantation in Adults. Is There an Age Related Cut-off?

Laske, Roman D.*,†; Dreyfuss, Michael; Stulman, Alan; Veraguth, Dorothe*,†; Huber, Alexander M.*,†; Röösli, Christof*,†

doi: 10.1097/MAO.0000000000002275
COCHLEAR IMPLANTS
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Objective: To analyze the impact of age at implantation on the cost-effectiveness of cochlear implantation (CI).

Study Design: Cost-utility analysis in an adapted Markov model.

Setting: Adults with profound postlingual hearing loss in a “high income” country.

Intervention: Unilateral and sequential CI were compared with hearing aids (HA).

Main Outcome Measure: Incremental cost-effectiveness ratio (ICER), calculated as costs per quality adjusted life year (QALY) gained (in CHF/QALY), for individual age and sex combinations in relation to two different willingness to pay thresholds. 1 CHF (Swiss franc) is equivalent to 1.01 USD.

Results: When a threshold of 50,000 CHF per QALY is applied, unilateral CI in comparison to HA is cost-effective up to an age of 91 for women and 89 for men. Sequential CI in comparison to HA is cost-effective up to an age of 87 for women and 85 for men. If a more contemporary threshold of 100,000 CHF per QALY is applied, sequential CI in comparison to unilateral CI is cost-effective up to an age of 80 for women and 78 for men.

Conclusions: Performing both sequential and unilateral CI is cost-effective up to very advanced ages when compared with hearing aids.

*Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich

University of Zurich, Zurich, Switzerland

Department of Industrial Engineering and Management, Jerusalem College of Technology, Jerusalem, Israel

Address correspondence and reprint requests to Roman D. Laske, M.D., Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstr. 24, 8091 Zürich, Switzerland; E-mail: laske@gmx.ch

R.D.L. and M.D. have contributed equally for this manuscript.

Sources of support: None.

Disclosure of funding: None.

The authors disclose no conflicts of interest.

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