Mini Review of the Cost-Effectiveness of Unilateral Osseointegrated Implants in Adults: Possibly Cost-Effective for the Correct Indication

Abstract

An osseointegrated implant (e.g. bone-anchored hearing aid, BAHA) is a surgically implantable device for unilateral sensorineural and unilateral or bilateral conductive hearing loss in patients who otherwise cannot use or do not prefer a conventional air conduction hearing aid (ACHA). The specific indications for an osseointegrated implant are evolving and dependent upon the country or regulatory body overseeing the provision of these devices. However, there are general groups of patients who would be likely to benefit, one such group being patients with congenital aural atresia. Given the anatomical aberrancies with aural atresia, these subjects cannot wear ACHAs. Another group of patients who may benefit from an osseointegrated implant over an ACHA are patients with chronically draining otological infections. As the provision of an osseointegrated implant requires a surgical procedure, there are inherent direct and indirect costs associated with its use beyond those required for an ACHA. Consideration of outcomes and cost-effectiveness for the osseointegrated implant versus the ACHA is prudent prior to making policy decisions in a setting of limited health care resources. We performed a mini review on all available cost-effectiveness analyses of osseointegrated implants published in Medline. There are only 2 contemporary cost-effectiveness analyses published to date. There is limited quality of life data available for patients living with an osseointegrated implant. As a result, the cost-effectiveness of the osseointegrated implant, specifically the BAHA, compared to conventional hearing aid devices remains unclear. However, there are clear indications for the BAHA when a standard hearing aid cannot be used (e.g. chronic draining ear) or in single-sided severe-to-profound hearing loss with reasonable hearing in the contralateral ear. The BAHA should not be considered interchangeable with the ACHA with regard to cost-effectiveness, but rather considered as an effective option for the patient for the correct indication.

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

“…There are no other studies to directly comparing economic analysis of Bonebridge to pBAHDs; however, there have been previous studies looking at the economic evaluation of pBAHDs versus bone conduction hearing aids suggesting cost-effectiveness in selected cases. 11,14,21…”

Minimally Invasive Ponto Surgery compared to the linear incision technique without soft tissue reduction for bone conduction hearing implants: study protocol for a randomized controlled trial

“…This technology has been reported to improve the quality of life for these patients, although the available data is limited [4, 5]. Recently, measuring quality of life and wellbeing using the concept of capabilities has gained more interest [6].…”

“…As reviewed by Crowson et al [4], only a few investigations addressed the cost-effectiveness of a BCHI intervention, resulting in uncertainty regarding cost-effectiveness. One retrospective study by Monksfield et al has been executed in the United Kingdom that compared gain in quality-adjusted life years to BCHI-related costs.…”

Minimally Invasive Ponto Surgery Versus the Linear Incision Technique With Soft Tissue Preservation for Bone Conduction Hearing Implants: A Multicenter Randomized Controlled Trial

“…The bone-anchored hearing system (BAHS) has become an accepted treatment option for subjects suffering from various types of hearing loss, such as conductive or mixed hearing loss or single-sided deafness, who are unable to benefit from conventional therapies, such as air conduction hearing aids or reconstructive middle ear surgery ( 1 , 2 ). It consists of a retro-auricular-placed titanium implant mounted with a percutaneous abutment, to which a sound processor can be attached.…”