Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial

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.