scholarly journals Understanding the Cost-Effectiveness of Hearing Aids and Surgery for the Treatment of Otosclerosis

2022 ◽  
Author(s):  
Danielle M. Gillard ◽  
Jeffrey D. Sharon
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hearing Aids ◽  
Cost Effective ◽  
Stapes Surgery ◽  
Cost Effective Method ◽  
Patient Reported ◽  
Complications Of Surgery ◽  
The Cost

Abstract Purpose of Review To summarize and critically review recent literature on the relative cost-effectiveness of hearing augmentation versus stapes surgery for the treatment of otosclerosis. Recent Findings Otosclerosis leads to reduced patient quality of life, which can be ameliorated by either stapes surgery, or hearing aid usage. The success of stapes surgery is high, and the risks of serious postoperative complications are low. Hearing aids don’t have the complications of surgery but are associated with long-term costs. Cost-effectiveness models have shown that stapes surgery is a cost-effective method for treating otosclerosis. Summary Both stapes surgery and hearing aids can improve patient-reported quality of life in otosclerosis. Stapes surgery has larger upfront costs and surgical risks, but hearing aids are associated with longer lifetime costs. Stapes surgery is cost-effective for the treatment of otosclerosis.

scholarly journals The cost-effectiveness of unilateral cochlear implants in UK adults

2021 ◽  
Author(s):  
Henry Cutler ◽  
Mutsa Gumbie ◽  
Emma Olin ◽  
Bonny Parkinson ◽  
Ross Bowman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Cochlear Implants ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Cost Effective ◽  
Profound Hearing Loss ◽  
Unit Costs ◽  
The Cost

Abstract Objective The National Institute for Health and Care Excellence (NICE) updated its eligibility criteria for unilateral cochlear implants (UCIs) in 2019. NICE claimed this would not impact the cost-effectiveness results used within its 2009 technology appraisal guidance. This claim is uncertain given changed clinical practice and increased healthcare unit costs. Our objective was to estimate the cost-effectiveness estimates of UCIs in UK adults with severe to profound hearing loss within the contemporary NHS environment. Methods A cost–utility analysis employing a Markov model was undertaken to compare UCIs with hearing aids or no hearing aids for people with severe to profound hearing loss. A clinical pathway was developed to estimate resource use. Health-related quality of life, potential adverse events, device upgrades and device failure were captured. Unit costs were derived mostly from the NHS data. Probabilistic sensitivity analysis further assessed the effect of uncertain model inputs. Results A UCI is likely to be deemed cost-effective when compared to a hearing aid (£11,946/QALY) or no hearing aid (£10,499/QALY). A UCI has an 93.0% and 98.7% likelihood of being cost-effective within the UK adult population when compared to a hearing aid or no hearing aid, respectively. ICERs were mostly sensitive to the proportion of people eligible for cochlear implant, discount rate, surgery and device costs and processor upgrade cost. Conclusion UCIs remain cost-effective despite changes to clinical practice and increased healthcare unit costs. Updating the NICE criteria to provide better access UCIs is projected to increase annual implants in adults and children by 70% and expenditure by £28.6 million within three years. This increased access to UCIs will further improve quality of life of recipients and overall social welfare.

scholarly journals Cost-effectiveness of ablation of ventricular tachycardia in ischaemic cardiomyopathy: limitations in the trial evidence base

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001155 ◽  
Author(s):  
Yang Chen ◽  
Manuel Gomes ◽  
Jason V Garcia ◽  
Ross J Hunter ◽  
Anthony W Chow ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ventricular Tachycardia ◽  
Cost Effectiveness ◽  
Catheter Ablation ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Ischaemic Cardiomyopathy ◽  
Patient Reported ◽  
Trial Evidence

ObjectiveCatheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy.MethodsA decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective.ResultsCatheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK’s National Institute for Health and Care Excellence.ConclusionCatheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.

scholarly journals The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation

2014 ◽  
Vol 18 (68) ◽  
pp. 1-206 ◽  
Author(s):  
Geoff Frampton ◽  
Petra Harris ◽  
Keith Cooper ◽  
Andrew Lotery ◽  
Jonathan Shepherd
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Patient Reported Outcomes ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Eye Surgery ◽  
Patient Reported

BackgroundElective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is operated on first. First-eye surgery can improve vision and quality of life. However, it is unclear whether or not cataract surgery on the second eye provides enough incremental benefit to be considered clinically effective and cost-effective.ObjectiveTo conduct a systematic review of clinical effectiveness and analysis of cost-effectiveness of second-eye cataract surgery in England and Wales, based on an economic model informed by systematic reviews of cost-effectiveness and quality of life.Data sourcesTwelve electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, The Cochrane Library and the Centre for Reviews and Dissemination databases were searched from database inception to April 2013, with searches updated in July 2013. Reference lists of relevant publications were also checked and experts consulted.Review methodsTwo reviewers independently screened references, extracted and checked data from the included studies and appraised their risk of bias. Based on the review of cost-effectiveness, a de novo economic model was developed to estimate the cost-effectiveness of second-eye surgery in bilateral cataract patients. The model is based on changes in quality of life following second-eye surgery and includes post-surgical complications.ResultsThree randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of health-related quality of life (HRQoL) met the inclusion criteria for the systematic reviews and, where possible, were used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses, and instead data were synthesised narratively. The RCTs assessed visual acuity, contrast sensitivity, stereopsis and several measures of HRQoL. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely to be of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. Studies did not provide evidence that second-eye surgery significantly affected HRQoL, apart from an improvement in the mental health component of HRQoL in one RCT. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life-years with an incremental cost-effectiveness ratio of £1964. Model results were most sensitive to changes in the utility gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness-to-pay thresholds of £10,000 and £20,000 is 100%.LimitationsClinical effectiveness studies were all conducted more than 9 years ago. Patients had good vision pre surgery which may not represent all patients eligible for second-eye surgery. For some vision-related patient-reported outcomes and HRQoL measures, thresholds for determining important clinical effects are either unclear or have not been determined.ConclusionsSecond-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, more up-to-date data are needed. A well-conducted RCT that reflects current populations and enables the estimation of health state utility values would be appropriate. Guidance is required on which vision-related, patient-reported outcomes are suitable for assessing effects of cataract surgery in the NHS and how these measures should be interpreted clinically.Study registrationThis project is registered as PROSPERO CRD42013004211.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme.

scholarly journals The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

2015 ◽  
Vol 19 (81) ◽  
pp. 1-246 ◽  
Author(s):  
Janine Dretzke ◽  
Deirdre Blissett ◽  
Chirag Dave ◽  
Rahul Mukherjee ◽  
Malcolm Price ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The Cost ◽  
Effectiveness Studies

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

Evaluating the cost-effectiveness of the hospital-based palliative care program at The Johns Hopkins Hospital.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 23-23
Author(s):  
Sarina Isenberg ◽  
David R Holtgrave ◽  
Chunhua Lu ◽  
John P McQuade ◽  
Brian Weir ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Of Care ◽  
Palliative Care Unit ◽  
Hospital Perspective ◽  
Life Years ◽  
The Cost

23 Background: The objectives of the study were to determine whether a Palliative Care Unit (PCU) provides benefits not just from a cost perspective, but from a patient and caregiver quality of life (QOL) perspective. Methods: (1) Calculate the total costs of the PCU; (2) Leverage a threshold analysis to estimate the Quality-Adjusted Life Years (QALYs) required for the PCU to be cost effective; and (3) Determine whether it is feasible for the program to yield the required number of QALYs. Setting was the Johns Hopkins Health System Palliative Care Unit (PCU) in Baltimore, MD. Analysis was based on patient volume from March 2013-2014. Results: There were 209 palliative patients. The costs for the societal perspective was $2,044,364 and the required number of QALYs to deem it cost effective were 11.36. The net costs for the hospital perspective was $625,777 (gross cost was $993,528; however, the program generated $367,751 in savings for the hospital through treating patients in the PCU as opposed to other functional units), and the required number of QALYs to deem it cost effective were 3.48. To determine whether the program is able to achieve the number of QALYs required, the study team generated aggregated QALYs based on other studies’ evidence for palliative care’s improvement of quality of life for patients and their caregivers. Combining the QALYs generated from the aggregated calculations for patients (0.12) and caregivers (4.60), the program had the potential to yield a total of 4.73 QALYs. Conclusions: This analysis suggests that the PCU is cost effective from the hospital perspective in the sense that the benefits it provides to patients’ and caregivers’ quality of life outweighs the cost of care. Future studies should continue to evaluate palliative care from a cost effectiveness perspective that incorporates a consideration of the quality of life improvements, rather than just cost-reduction.

scholarly journals Determining the cost-effectiveness requirements of an exoskeleton preventing second hip fractures using value of information

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stefania Manetti ◽  
Giuseppe Turchetti ◽  
Francesco Fusco
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Secondary Analyses ◽  
The Cost

Abstract Background Falls may lead to hip fractures, which have a detrimental effect on the prognosis of patients as well as a considerable impact on healthcare expenditures. Since a secondary hip fracture (SHF) may lead to even higher costs than primary fractures, the development of innovative services is crucial to limit falls and curb costs in high-risk patients. An early economic evaluation assessed which patients with a second hip fracture could benefit most from an exoskeleton preventing falls and whether its development is feasible. Methods The life-course of hip fractured patients presenting with dementia or cardiovascular diseases was simulated using a Markov model relying on the United Kingdom administrative data and complemented by published literature. A group of experts provided the exoskeleton parameters. Secondary analyses included a threshold analysis to identify the exoskeleton requirements (e.g. minimum impact of the exoskeleton on patients’ quality of life) leading to a reimbursable incremental cost-effectiveness ratio. Similarly, the uncertainty around these requirements was modelled by varying their standard errors and represented alongside population Expected Value of Perfect Information (EVPI). Results Our base-case found the exoskeleton cost-effective when providing a statistically significant reduction in SHF risk. The secondary analyses identified 286 cost-effective combinations of the exoskeleton requirements. The uncertainty around these requirements was explored producing further 22,880 scenarios, which showed that this significant reduction in SHF risk was not necessary to support the exoskeleton adoption in clinical practice. Conversely, a significant improvement in women quality of life was crucial to obtain an acceptable population EVPI regardless of the cost of the exoskeleton. Conclusions Our study identified the exoskeleton requisites to be cost-effective and the value of future research. Decision-makers could use our analyses to assess not only whether the exoskeleton could be cost-effective but also how much further research and development of the exoskeleton is worth to be pursued.

Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer.

1998 ◽  
Vol 16 (3) ◽  
pp. 1022-1029 ◽  
Author(s):  
J A Hayman ◽  
B E Hillner ◽  
J R Harris ◽  
J C Weeks
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Local Recurrence ◽  
Early Stage ◽  
Cost Effective ◽  
Conservative Surgery ◽  
The Cost

PURPOSE To examine the cost-effectiveness of radiation therapy following conservative surgery for early-stage breast cancer. METHODS Using a Markov model, a cost-utility analysis was performed to compare a strategy of radiation therapy versus no radiation therapy in a hypothetical cohort of 60-year-old women following conservative surgery. Local recurrence, distant recurrence, and survival rates used in the model were derived from randomized trial data. Utilities for the nonmetastatic health states were collected from actual patients. Direct medical costs were estimated using data from a single institution. Transportation and time costs were also estimated. Years of life, quality-adjusted life-years (QALYs), costs, and incremental cost/QALY over a 10-year time horizon were calculated by the model for each strategy. RESULTS The addition of radiation therapy results in a cost increase of $9,800 per patient, no change in life expectancy, and an increase of 0.35 QALYs per patient, which leads to an incremental cost-effectiveness ratio of $28,000/QALY, which is well below $50,000/QALY, a commonly cited threshold for cost-effective care. Sensitivity analysis shows the ratio to be heavily influenced by the cost of radiation therapy and the quality-of-life benefit that results from decreased risk of local recurrence. CONCLUSION Radiation therapy following conservative surgery is cost-effective compared with other accepted medical interventions. This study illustrates the importance of considering an intervention's effect on quality of life, as well as survival in defining cost-effectiveness.

Cost-effectiveness of four living-donor nephrectomy techniques from a hospital perspective

2019 ◽  
Vol 35 (11) ◽  
pp. 2004-2012 ◽  
Author(s):  
Hamza Achit ◽  
Francis Guillemin ◽  
Georges Karam ◽  
Marc Ladrière ◽  
Cedric Baumann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Open Surgery ◽  
Cost Effective ◽  
Robot Assisted ◽  
Hospital Perspective ◽  
Operative Outcomes ◽  
The Cost

Abstract Background In Europe, transplantation centres use different nephrectomy techniques: open surgery, and standard, hand-assisted and robot-assisted laparoscopies. Few studies have analysed the disparity in costs and clinical outcomes between techniques. Since donors are healthy patients expecting minimum pain and fast recovery, this study aimed to compare the cost-effectiveness of four nephrectomy techniques focusing on early surgical outcomes, an essential in the donation act. Methods A micro-costing approach was used to estimate the cost of implementation from a hospital perspective. Estimates took into account sterilization costs for multiple-use equipment, costs for purchasing single-use equipment, staff and analgesics. The study recruited donors in 20 centres in France. Quality of life by EuroQol-5D was assessed preoperatively, and 4 and 90 days post-operatively. Two effectiveness indicators were built: quality-of-life recovery and post-operative pain days averted (PPDA). The study was registered at ClinicalTrials.gov NCT02830568, on 10 June 2010. Results A total of 264 donors were included; they underwent open surgery (n = 65), and standard (n = 65), hand-assisted (n = 65) and robot-assisted laparoscopies (n = 69). Use of the nephrectomy techniques differed greatly in cost of implementation and immediate post-operative outcomes but not in clinical outcomes at 90 days. At 4 days, hand-assisted laparoscopy provided the lowest cost per quality-of-life recovery unit of effectiveness (%) and PPDA (days) (€2056/40.1%/2.3 days, respectively). Robot-assisted laparoscopy was associated with the best post-operative outcomes but with the highest cost (€3430/59.1%/2.6 days). Conclusion Hand-assisted, standard and robot-assisted laparoscopies are cost-effective techniques compared with open surgery. Hand-assisted surgery is the most cost-effective procedure. Robot-assisted surgery requires more healthcare resource use but enables the best clinical outcome.

scholarly journals Individualized quality of life benefit and cost-effectiveness estimates of proton therapy for patients with oropharyngeal cancer

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
N. Patrik Brodin ◽  
Rafi Kabarriti ◽  
Clyde B. Schechter ◽  
Mark Pankuch ◽  
Vinai Gondi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Cost Effectiveness ◽  
Proton Therapy ◽  
Oropharyngeal Cancer ◽  
Normal Tissue ◽  
Cost Effective ◽  
Intensity Modulated ◽  
The Cost

Abstract Background Proton therapy is a promising advancement in radiation oncology especially in terms of reducing normal tissue toxicity, although it is currently expensive and of limited availability. Here we estimated the individual quality of life benefit and cost-effectiveness of proton therapy in patients with oropharyngeal cancer treated with definitive radiation therapy (RT), as a decision-making tool for treatment individualization. Methods and materials Normal tissue complication probability models were used to estimate the risk of dysphagia, esophagitis, hypothyroidism, xerostomia and oral mucositis for 33 patients, comparing delivered photon intensity-modulated RT (IMRT) plans to intensity-modulated proton therapy (IMPT) plans. Quality-adjusted life years (QALYs) lost were calculated for each complication while accounting for patient-specific conditional survival probability and assigning quality-adjustment factors based on complication severity. Cost-effectiveness was modeled based on upfront costs of IMPT and IMRT, and the cost of acute and/or long-term management of treatment complications. Uncertainties in all model parameters and sensitivity analyses were included through Monte Carlo sampling. Results The incremental cost-effectiveness ratios (ICERs) showed considerable variability in the cost of QALYs spared between patients, with median $361,405/QALY for all patients, varying from $54,477/QALY to $1,508,845/QALY between individual patients. Proton therapy was more likely to be cost-effective for patients with p16-positive tumors ($234,201/QALY), compared to p16-negative tumors ($516,297/QALY). For patients with p16-positive tumors treated with comprehensive nodal irradiation, proton therapy is estimated to be cost-effective in ≥ 50% of sampled cases for 8/9 patients at $500,000/QALY, compared to 6/24 patients who either have p16-negative tumors or receive unilateral neck irradiation. Conclusions Proton therapy cost-effectiveness varies greatly among oropharyngeal cancer patients, and highlights the importance of individualized decision-making. Although the upfront cost, societal willingness to pay and healthcare administration can vary greatly among different countries, identifying patients for whom proton therapy will have the greatest benefit can optimize resource allocation and inform prospective clinical trial design.

scholarly journals The cost-effectiveness of Cochlear implants in Swedish adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mutsa Gumbie ◽  
Emma Olin ◽  
Bonny Parkinson ◽  
Ross Bowman ◽  
Henry Cutler
Keyword(s):  
Quality Of Life ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Cochlear Implants ◽  
Hearing Aid ◽  
Cost Effective ◽  
Profound Hearing Loss ◽  
Lifetime Horizon ◽  
The Cost

Abstract Background Research has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults. However, only 13% of eligible Swedish adults currently use a unilateral CI. The objective was to estimate the cost-effectiveness of unilateral CIs compared to a hearing aid for Swedish adults with severe to profound hearing loss. Methods A Markov model with a lifetime horizon and six-month cycle length was developed to estimate the benefits and costs of unilateral CIs from the Swedish health system perspective. A treatment pathway was developed through consultation with clinical experts to estimate resource use and costs. Unit costs were derived from the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions. Health outcomes were reported in terms of Quality Adjusted Life Years (QALYs). Results Unilateral CIs for Swedish adults with severe to profound hearing loss are likely to be deemed cost-effective when compared to a hearing aid (SEK 140,474 per QALY gained). The results were most sensitive to the age when patients are implanted with a CI and the proportion of patients eligible for CIs after triage. Conclusions An increase in the prevalence of Swedish adults with severe to profound hearing loss is expected as the population ages. Earlier implantation of unilateral CIs improves the cost-effectiveness among people eligible for CIs. Unilateral CIs are an efficacious and cost-effective option to improve hearing and quality of life in Swedish adults with severe to profound hearing loss.

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