Cost-Utility Analysis Of Cochlear Implantation In Adults With Single-Sided Deafness: Austrian And German Perspective

Background: Single-sided deafness (SSD) is associated with a loss of binaural hearing. Major limitations of such patients are poor speech understanding in noisy environments and a lack of spatial hearing. To date, cochlear implantation is the most promising approach to overcome these deficits in this group of patients. Objective: Cost-effectiveness analyses of cochlear implantation in patients with unilateral deafness. The model targets Austrian and German SSD patients who can either opt for treatment with a cochlear implant (CI) or decide against a CI and stay without any treatment. Methods: A Markov model analyzed as microsimulation was developed using TreeAge Pro 2019 software. Pre- and postoperative utility values generated with HUI-3 were used to populate the model. Costs covered by the national insurance were considered. Costs and utilities were discounted by 3%. A model time horizon of 20 years was set. Results: According to Austrian base-case analysis, the incremental cost-utility ratio (ICUR) was euro34845.2 per quality-adjusted life year gained when comparing the "CI strategy" to the "no treatment strategy." The ICUR is marginally lower when adapting a German cost perspective-it was euro31601.25 per quality-adjusted life year gained. Sensitivity analyses showed that the cost-effectiveness results are stable. Analyses also showed that the longer the time horizon is set, the more favorable the cost-effectiveness result is. Conclusions: Based on currently available data, the Markov microsimulation model suggests that cochlear implantation is cost-effective in Austrian and German patients with SSD if no other treatment option is considered within the model.