OBJECTIVES : In February 2019 the National Institute for Health and Care Excellence (NICE) updated its guidance on eligibility criteria for unilateral cochlear implants in the UK. However, guidance on bilateral cochlear implants were not updated, despite advancements in technology, price reductions and refined treatment pathways. Research has shown significant improvements in clinical outcomes and quality of life following cochlear implantation (CI). Our objective was to update estimates of the cost-effectiveness of unilateral and bilateral CIs in adults in the UK.

METHODS : A Markov model with a lifetime horizon and National Health Service perspective was used to investigate the benefits and costs of no hearing aids, hearing aids, unilateral cochlear implants, simultaneous bilateral and sequential bilateral cochlear implants. A probabilistic sensitivity analysis (PSA) was undertaken to further assess the effect of uncertain model inputs on the cost effectiveness of unilateral and bilateral cochlear implants. Systematic literature reviews of economic evaluations and utilities were undertaken to inform the model. A clinical pathway was developed through consultation with clinical experts. Unit costs were derived from grey literature and clinical expert opinion. The ICER was compared to a cost effectiveness threshold of £20,000 per QALY gained.

RESULTS : A unilateral CI is deemed cost effective when compared to a hearing aid or no hearing aid (ICER of £11,988 and £10,535 per QALY gained). Simultaneous bilateral (ICER of £17,795 and £15,840 per QALY gained) and sequential bilateral (ICER of £20,312 and £17,989 per QALY gained) CIs are potentially cost effective when compared to a hearing aid or no hearing aid, however they have a much lower likelihood of being cost effective when compared to a unilateral CI.

CONCLUSIONS : Estimated ICERs within this study reflect current data on the benefits and costs of CIs. Further research is required to capture additional benefits from a cochlear implant for bilateral CIs in adults.