OBJECTIVES: Bone conduction hearing implants (BCHI) positively impact quality of life and are suitable for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD). BCHIs are categorized as percutaneous or transcutaneous solutions based on the attachment method. Selecting an optimal solution requires consideration of general indications, guidelines, safety, patient preferences and costs. This study evaluated the cost-effectiveness of an active transcutaneous solution (Osia^® System [Osia]) over percutaneous implants to treat CHL, MHL, and SSD in Sweden. The cost-effectiveness of Osia has been studied in the Australian setting, but not from a European perspective or versus percutaneous devices.

METHODS: We used a Markov model to simulate a cohort of adult patients aged ≥59 years receiving either Osia or percutaneous BCHIs. Patients initially received an implant and then remained in this health state or moved to a second health state without a device, depending on the probability of explanation and device non-use. Utilities and complication rates were sourced from the literature and the cost of complications and implantation from the National Board of Health and Welfare in Sweden, Socialstyrelsen. We considered the Swedish healthcare perspective and assumed a six-month cycle and lifetime horizon. The main outcome was incremental cost per quality-adjusted life years (QALY) gained.

RESULTS: Osia was associated with an increase in cost and QALYs of SEK 78,062 and 0.73 respectively, resulting in an incremental cost-effectiveness ratio (ICER) equal to SEK 106,638/QALY gained. The main drivers were baseline age, the cost of surgery and the difference in utilities between the two interventions.

CONCLUSIONS: Osia is cost-effective compared to percutaneous devices over a lifetime horizon for patients with CHL, MHL, and SSD, when applying the low to moderate cost/ QALY willingness-to-pay thresholds identified by the Swedish Agency for Health Technology Assessment and Assessment of Social Services.