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The cost-effectiveness of unilateral cochlear implants in UK adults


  • Henry Cutler

    (Macquarie University Centre for the Health Economy)

  • Mutsa Gumbie

    (Macquarie University Centre for the Health Economy)

  • Emma Olin

    (Macquarie University Centre for the Health Economy)

  • Bonny Parkinson

    (Macquarie University Centre for the Health Economy)

  • Ross Bowman

    (Health Technology Analysts)

  • Hafsa Quadri

    (Cochlear Limited)

  • Timothy Mann

    (Cochlear Limited)


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.

Suggested Citation

  • Henry Cutler & Mutsa Gumbie & Emma Olin & Bonny Parkinson & Ross Bowman & Hafsa Quadri & Timothy Mann, 2022. "The cost-effectiveness of unilateral cochlear implants in UK adults," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 763-779, July.
  • Handle: RePEc:spr:eujhec:v:23:y:2022:i:5:d:10.1007_s10198-021-01393-y
    DOI: 10.1007/s10198-021-01393-y

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    References listed on IDEAS

    1. Andrew Briggs & Ron Goeree & Gord Blackhouse & Bernie O'Brien, 2001. "Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for Gastro-Esophogeal Reflux Disease," Centre for Health Economics and Policy Analysis Working Paper Series 2001-01, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    2. Piers Dawes & Richard Emsley & Karen J Cruickshanks & David R Moore & Heather Fortnum & Mark Edmondson-Jones & Abby McCormack & Kevin J Munro, 2015. "Hearing Loss and Cognition: The Role of Hearing Aids, Social Isolation and Depression," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-9, March.
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    More about this item


    Cost–utility; Cochlear implant; Hearing aid; Hearing loss; Economic evaluation;
    All these keywords.

    JEL classification:

    • D61 - Microeconomics - - Welfare Economics - - - Allocative Efficiency; Cost-Benefit Analysis
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I19 - Health, Education, and Welfare - - Health - - - Other


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