The Cost-utility of bilateral cochlear implantation: A Systematic Review.

Abstract

OBJECTIVES/HYPOTHESIS: The (cost-)effectiveness and the subsequent reimbursement of bilateral cochlear implantation has been vigorously debated. Throughout the world healthcare commissioners are still struggling with the decision to reimburse bilateral implantation. Given this debate, this study's objective was to review the literature on the cost-utility of bilateral cochlear implantation in both children and adults, and study the impact of the used cost and quality-of-life estimates. STUDY DESIGN: Systematic review. METHODS: Electronic databases were systematically searched for relevant studies published up to December 2010. All studies reporting on cost-utility and bilateral cochlear implantation were included. RESULTS: Five studies fulfilled the inclusion criteria. The methodological quality of the studies, assessed with Drummond's checklist of cost-effectiveness studies, varied from poor to good. The assumptions regarding gain in quality-adjusted life years (QALYs) and direct costs varied among studies, resulting in a varying gain in QALY (0.38-1.93). The incremental cost-effectiveness ratios for bilateral cochlear implantation differed widely across studies for both children and adults (children: $30,973-$94,340; adults: $38,189-$132,160) and were inversely related to the gain in QALY, cost reductions due to simultaneous implantation, and discounts offered on the second implant. CONCLUSIONS: The incremental cost-effectiveness ratios for bilateral cochlear implantation vary widely and appear to depend on the gain in QALY due to the second implant. The results of this review confirm that more empirical data are required to estimate the cost-effectiveness of bilateral implantation. Laryngoscope, 121:2604-2609, 2011.