COST-EFFECTIVENESS OF COCHLEAR IMPLANTS IN OLDER ADULTS: THE ROLE OF COGNITIVE DECLINE AND FALLS
Author(s)
Bonny Parkinson, BEc, MSc, PhD.
Associate Professor, Centre for the Health Economy, SYDNEY, Australia.
Associate Professor, Centre for the Health Economy, SYDNEY, Australia.
OBJECTIVES: Economic evaluations of unilateral cochlear implants (UCIs) rarely incorporate the impact on cognitive decline and falls, despite emerging evidence that UCIs may reduce these outcomes and address health system priorities. This study aimed to estimate the cost-effectiveness of UCIs versus no hearing aids (traditional candidates, TCs) and versus hearing aids (marginal hearing aid users, MHAUs) across recipient age groups, while explicitly incorporating mild cognitive impairment (MCI), dementia, and falls.
METHODS: A de novo cost-utility analysis was adapted from a previously validated Markov model comparing UCI with hearing aids and no hearing aids in adults aged ≥50 years with severe-to-profound hearing loss in the United Kingdom (UK). Long-term health states for MCI and dementia, and temporary serious-fall events were included. Parameter values were informed by systematic reviews. The analysis adopted a UK National Health Service and social care perspective over a lifetime horizon, discounting costs and quality-adjusted life years (QALYs) at 3.5% annually. Deterministic, scenario and probabilistic sensitivity analyses were undertaken.
RESULTS: The model estimated that UCIs would reduce dementia cases (27% to 43%) and falls (23% to 39%), with a similar impact on their associated costs (dementia: 29% to 46%, falls: 23% to 39%), versus hearing aids and no hearing aids across all age groups. Incorporating cognitive decline and serious falls improved the cost-effectiveness of UCIs, particularly for older recipients. As an example, for a 65-year-old recipient, the incremental cost-effectiveness ratio (ICER) improved from around GBP£12,000/QALY gained (net monetary benefit [NMB] = £37,000, return on investment [ROI] = 92%) to £8,000/QALY gained (NMB = £47,000, ROI = 122%) versus no hearing aids for TCs. Similar improvements were observed for UCIs versus hearing aids for MHAUs.
CONCLUSIONS: UCIs are a cost-effective intervention that would help address health system priorities regarding dementia, frailty and falls prevention.
METHODS: A de novo cost-utility analysis was adapted from a previously validated Markov model comparing UCI with hearing aids and no hearing aids in adults aged ≥50 years with severe-to-profound hearing loss in the United Kingdom (UK). Long-term health states for MCI and dementia, and temporary serious-fall events were included. Parameter values were informed by systematic reviews. The analysis adopted a UK National Health Service and social care perspective over a lifetime horizon, discounting costs and quality-adjusted life years (QALYs) at 3.5% annually. Deterministic, scenario and probabilistic sensitivity analyses were undertaken.
RESULTS: The model estimated that UCIs would reduce dementia cases (27% to 43%) and falls (23% to 39%), with a similar impact on their associated costs (dementia: 29% to 46%, falls: 23% to 39%), versus hearing aids and no hearing aids across all age groups. Incorporating cognitive decline and serious falls improved the cost-effectiveness of UCIs, particularly for older recipients. As an example, for a 65-year-old recipient, the incremental cost-effectiveness ratio (ICER) improved from around GBP£12,000/QALY gained (net monetary benefit [NMB] = £37,000, return on investment [ROI] = 92%) to £8,000/QALY gained (NMB = £47,000, ROI = 122%) versus no hearing aids for TCs. Similar improvements were observed for UCIs versus hearing aids for MHAUs.
CONCLUSIONS: UCIs are a cost-effective intervention that would help address health system priorities regarding dementia, frailty and falls prevention.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE425
Topic
Clinical Outcomes, Economic Evaluation, Medical Technologies
Disease
Geriatrics, Sensory System Disorders (Ear, Eye, Dental, Skin)