The Cost-Effectiveness of Bimodal Stimulation Compared to Unilateral and Bilateral Cochlear Implant Use in Adults with Bilateral Severe to Profound Deafness

Theriou, Chloi; Fielden, Claire; Kitterick, Pádraig T.

doi:10.1097/aud.0000000000000727

Cited by 10 publications

(8 citation statements)

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“…This remarkable additional improvement was seen in all subdomains of the NCIQ: primary sound perception, advanced sound perception, speech production, self-esteem, activity, and social interactions. Our results corroborate these of others [ 10 , 12 , 23 ] and fully justify the medical effort.…”

Section: Discussionsupporting

confidence: 92%

“…The theoretically potential disadvantages include bilateral vestibular alterations, surgical complications, and cost [6][7][8]. The debate about cost-effectiveness is particularly controversial [9][10][11]. Up to this point, most research investigating bilateral CI supply has focused on auditory improvement, including sound localisation and enhanced speech perception, but little is known about the subjectively experienced changes created by a CI, and very few studies have analysed the health-specific quality of life changes due to a second CI [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Single-centre experience and practical considerations of the benefit of a second cochlear implant in bilaterally deaf adults

Péus

Pfluger

Häußler

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Bilateral cochlear implant (CI) implantation is increasingly used in the auditory rehabilitation of bilaterally deafened adults. However, after successful unilateral implantation, objective patient counselling is essential. Methods We investigated the extra benefit of a second CI in adults in terms of health-related quality of life, tinnitus, stress, anxiety, depression, quality of hearing, and speech recognition. Hearing ability was assessed by using the Freiburg monosyllable speech discrimination test (FB MS) and the Oldenburg sentence test with azimuth variations. In a prospective patient cohort, we administered validated questionnaires before a CI, after a first CI and after a second CI implantation. Results The study included 29 patients, made up of nine women and 20 men. The median time between the first and the second implantation was 23 months. The mean total NCIQ score and TQ before a CI improved significantly after both implantations. Stress, anxiety, and depression were stable over time and were not significantly affected by CI implantations. Speech recognition with noise significantly improved after the first and again after the second CI. Correlation analysis showed a strong connection between auditory performance and HRQoL. Conclusion We demonstrated that a unilateral CI benefitted many fields and that the second sequential CI leads again to additional improvement. Bilateral CI implantation should, therefore, be the standard form of auditory rehabilitation in deafened adults.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Single-centre experience and practical considerations of the benefit of a second cochlear implant in bilaterally deaf adults

Péus

Pfluger

Häußler

et al. 2020

Eur Arch Otorhinolaryngol

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“…Faced with a range of estimates of varying quality, systematic reviews have concluded that the gain in HRQL associated with bilateral compared with unilateral implantation is sufficiently small (0.03, Bond et al 2009;0.035, Health Quality Ontario 2018) to prompt uncertainty about whether bilateral implantation gains sufficient additional QALYs to justify its costs (Bond et al 2009;Lammers et al 2011;Health Quality Ontario 2018;Theriou et al 2019). Analysts have reached those conclusions both when they have decided on balance that bilateral implantation is a TABLE 1.…”

Section: Introductionmentioning

confidence: 99%

Development and Critical Evaluation of a Condition-Specific Preference-Based Measure Sensitive to Binaural Hearing in Adults: The York Binaural Hearing–Related Quality-of-Life System

2021

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Objectives: The widely-used generic preference-based measures of health-related quality of life—the EuroQol Descriptive System (EQ-5D) and the Health Utilities Index (HUI3)—are limited in their response to technologies that improve hearing. The EQ-5D lacks construct validity for hearing, while the HUI3 is restricted by a ceiling effect and by using speech reception as the only evidence of the ability to hear. Consequently, neither measure consistently registers benefits from binaural hearing, such as those from bilateral versus unilateral cochlear implantation. The objectives were to test whether informants value binaural hearing, to develop a condition-specific preference-based measure sensitive to binaural hearing, to assess the psychometric properties of the new instrument, and to determine whether it meets requirements for informing judgments of cost-effectiveness: does it measure greater gains than do the generic preference-based measures, while avoiding exaggerating losses, and displaying sensitivity to side effects? Design: Three levels of function, ranging from no difficulty to great difficulty, were defined on each of three dimensions where listening is easier or more successful when hearing is binaural rather than monaural: perception of speech in spatially separated noise, localization of sounds, and effort and fatigue. Informants (N = 203) valued the 27 combinations of levels and dimensions in a time trade-off task with a 10-year time frame to provide a value of binaural-related quality of life (“binaural utility”) for each combination. A questionnaire was compiled to allow respondents to report their level of function on each dimension so that a value of binaural utility could be assigned to them. The questionnaire and the age-standardized valuations constitute The York Binaural Hearing–Related Quality-of-Life System (YBHRQL). Adult users of unilateral implants (N = 8), bilateral implants (N = 11), or bimodal aiding (N = 9) undertook performance tests of spatial listening and completed the HUI3, EQ-5D, and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires. They completed the YBHRQL questionnaire 24 and 38 mo later. Results: Despite long intervals between measurements, the YBHRQL demonstrated desirable psychometric properties: good construct validity evidenced by significant correlations with performance measures and the SSQ index; a greater ability than the EQ-5D or HUI3 to distinguish unilateral, bimodal, and bilateral listening; and good reproducibility. The YBHRQL did not exaggerate losses of utility but was insensitive to a potential side effect of implantation (pain/discomfort). It measured a gain in utility from bilateral compared with unilateral implantation (median = 0.11, interquartile range, 0.03 to 0.16) that was greater than the gain measured by the EQ-5D (0.00, 0.00 to 0.00) but not the HUI3 (0.00, 0.00 to 0.17). Conclusions: The YBHRQL summarizes the contribution of binaural hearing to quality of life by combining the functional status of a listener with the preferen...

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“…Batched citations. 9,17-20,23,27,30-32,37,39,42-48,51,52,54,55,57,58,60,62,65,66,68,69,73-77,82-84,88,91,92,95,98,99,103,105,109,113,114,117,120-123,125,127-131][ 16,26,28,36,38,40,49,56,59,63,64,[70][71][72]79,81,85,86,89,90,93,94,96,97,[100][101][102]104,106,107,110,111] …”

mentioning

confidence: 99%

Evidence gaps in economic analyses of hearing healthcare: A systematic review

et al. 2021

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Background: Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. Methods: We searched the published literature through 14 June 2020 and our inclusion criteria included decision model-based cost-effectiveness analyses that addressed diagnosis, treatment, or prevention of hearing loss. Two investigators screened articles for inclusion at the title, abstract, and full-text levels. Data were abstracted and the studies were assessed for the qualities of model structure, data assumptions, and reporting using a previously published quality scale. Findings: Of 1437 articles identified by our search, 117 unique studies met the inclusion criteria. Most of these model-based analyses were set in high-income countries (n = 96, 82%). The evaluated interventions were hearing screening (n = 35, 30%), cochlear implantation (n = 34, 29%), hearing aid use (n = 28, 24%), vaccination (n = 22, 19%), and other interventions (n = 29, 25%); some studies included multiple interventions. Eighty-six studies reported the main outcome in quality-adjusted or disability-adjusted life-years, 24 of which derived their own utility values. The majority of the studies used decision tree (n = 72, 62%) or Markov (n = 41, 35%) models. Forty-one studies (35%) incorporated indirect economic effects. The median quality rating was 92/ 100 (IQR:72À100). Interpretation: The review identified a large body of literature exploring the economic efficiency of hearing healthcare interventions. However, gaps in evidence remain in evaluation of hearing healthcare in low-and middle-income countries, as well as in investigating interventions across the lifespan. Additionally, considerable uncertainty remains around productivity benefits of hearing healthcare interventions as well as utility values for hearing-assisted health states. Future economic evaluations could address these limitations.

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The Cost-Effectiveness of Bimodal Stimulation Compared to Unilateral and Bilateral Cochlear Implant Use in Adults with Bilateral Severe to Profound Deafness

Cited by 10 publications

References 50 publications

Single-centre experience and practical considerations of the benefit of a second cochlear implant in bilaterally deaf adults

Single-centre experience and practical considerations of the benefit of a second cochlear implant in bilaterally deaf adults

Development and Critical Evaluation of a Condition-Specific Preference-Based Measure Sensitive to Binaural Hearing in Adults: The York Binaural Hearing–Related Quality-of-Life System

Evidence gaps in economic analyses of hearing healthcare: A systematic review

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