Cost-utility Analysis of Cochlear Implantation in Pediatric Unilateral Hearing Loss

Introduction: Cochlear implantation (CI) is the only intervention capable of restoring true binaural hearing in pediatric unilateral hearing loss (UHL), leading to better auditory performance and patient-reported outcomes. However, variable device use raises questions about long-term value. This study assesses cost-utility of CI for pediatric UHL using quality-adjusted life years (QALYs), incorporating Speech, Spatial, and Qualities of Hearing Scale (SSQ) outcomes and device non-use rates.

Methods: A Markov model was constructed estimating incremental health utility (in QALYs) attributable to CI for UHL, accounting for health utility gain (using Health Utility Index-3 [HUI-3]), device use rates and life expectancy, with inputs derived from published literature. Lifetime QALY benefit determined the incremental cost-effectiveness ratio (ICER) assuming a $50,000 CI cost.

Results: CI recipients showed mean SSQ improvement of +1.85 (SD 1.4). Using normative HUI-3 SD (0.24) and assuming similar effect size, this approximates +0.32 HUI-3 benefit. A conservative +0.12 HUI-3 gain, consistent with hearing-aid data, was applied. Average CI use was 70% (range 48-89%), yielding +0.084 annual QALY. Assuming implantation at age 5, life expectancy of 78 years, and 3% annual discount rate, lifetime benefit was +2.5 QALY, with an ICER of $20,000, which is below the $100,000 willingness-to-pay threshold. At 48% and 89% use, lifetime benefits were 1.71 and 3.17 QALYs, with ICERs of $29,202 and $15,749, respectively.

Conclusions: Across a wide-ranging use rates, this modeling reveals significant cost-effectiveness and lifetime QALY improvement of CI for pediatric UHL. Incorporating additional costs and downstream benefits related to speech, education and productivity would further strengthen these findings.