Longitudinal economic analysis of Bonebridge 601 versus percutaneous bone‐anchored hearing devices over a 5‐year follow‐up period

Abstract

Objectives: Percutaneous bone-anchored hearing devices (pBAHDs) are the most commonly used bone conduction implants (BCI). Concerns surround the long-term complications, notably skin-related, in patients with percutaneous abutments. The active transcutaneous BCI Bonebridge system can help avoid some of these pitfalls but is often considered a second-line option due to various factors including perceived increased overall costs. Design: Longitudinal economic analysis of Bonebridge BCI 601 versus pBAHD over a 5-year follow-up period. Setting: A specialist hearing implant centre. Participants: Adult patients (≥16 years) with conductive hearing loss, mixed hearing loss or single-sided deafness, who received a Bonebridge or pBAHD implant between 1/7/2013 and 1/12/2018 with a minimum 12-month follow-up. Main outcome measures: We compared the mean costs per implanted patient for both implants at 1, 3 and 5 years postoperative time points. Clinical effectiveness was evaluated using objective and patient-reported outcome measures. Results: The mean total cost per patient of Bonebridge was significantly higher than pBAHD at 1-year post-implantation (£8512 standard deviation [SD] £715 vs £5590 SD £1394, P < .001); however, by 5-years post-implantation this difference was no longer statistically significant (£12 453 SD £2159 vs £12 575 SD £3854, P > .05). The overall cost convergence was mainly accounted for by the increased long-term complications, revision surgery rates and higher cost of the pBAHD external processor compared to Bonebridge. Conclusions: Long-term costs of Bonebridge to healthcare providers are comparable to pBAHDs, whilst offering lower complication rates, comparable audiological benefit and patient satisfaction. Bonebridge should be considered as a first-line BCI option in appropriate cases.

Experience With the New Active Transcutaneous Bone‐Conduction Implant With Smaller Dimensions

“…Notably, implantations with lifts could potentially result in skin dehiscence or wound infections due to extensive pressure on the skin by the elevated implant. However, as reported by previous studies, implantations with lifts were not associated with any complications in the BB601 1,3,5 nor in the new generation BB602, 10 which goes in hand with our current results.…”

“…Similarly to BB602, the old generation BB601 also showed beneficial results accompanied by low complication rates. However, a low number of devices warranted an explanation, mostly due to medical reasons 1,3‐5 . We reported on 2 BB602 implantation following a previous explantation of the BB601 on the same side due to technical failure and wound dehiscence.…”

“…However, a low number of devices warranted an explanation, mostly due to medical reasons. 1,[3][4][5] We reported on 2 BB602 implantation following a previous explantation of the BB601 on the same side due to technical failure and wound dehiscence. Importantly, both of them had satisfactory outcomes, and no complications occurred with the new device.…”

“…Bonebridge 602 (BB602; Medel) is a recently introduced, active transcutaneous bone‐anchored hearing implant with a smaller dimension than the previous version, Bonebridge 601 (BB601; Medel). In particular, the new version features a modified internal part, which enables a reduction in implant height and reduces the needed drilling depth 1‐5 . These adjustments facilitate implantation in demanding anatomic cases 2,6 .…”

Comparison of Transcutaneous and Percutaneous Implantable Hearing Devices for the Management of Congenital Aural Atresia: A Systematic Review and Meta-Analysis

“…Although no cost analysis studies have been conducted specifically in patients with CAAwith implantable BCDs, two studies have investigated the economic implications of choice between tBCD and pBCD. These show that early costs tend to be higher among tBCD, but follow-up costs related to office visits for complications and revision surgery are higher among the percutaneous group (77), which can reduce the cost gap over time (78). A well-designed cost analysis specifically among patients with CAA would be useful for informing future decisions.…”