OBJECTIVES: Primary objectives of this study are to estimate cost-utility of providing cochlear implantation (CI) under public health insurance schemes in Thailand and its financial impact to the Thai government. METHODS: A model-based economic analysis using decision tree was constructed to estimate the costs and quality adjusted life years (QALYs) gained from providing unilateral CI and rehabilitation services for eligible profoundly deaf people, namely 1) preligually deaf children; 2) prelingually deaf adults; and 3) postlingually deaf adults. The economic evaluation was conducted using the societal viewpoint, which included both direct and indirect costs. The costs and effectiveness of CI and rehabilitation, and mortality data were based on the Thai setting, though the utility gained from CI were obtained from a systematic search of international literature. Probabilistic sensitivity analysis was conducted to incorporate the impact of parameter uncertainty. Lifetime cost of patients undertaking CI was performed to estimate the government’s budget impact for the next ten years. RESULTS: Providing CI and rehabilitation for prelingually deaf children and postlingually deaf adults were cost-effective under the Thai setting given the willingness to pay threshold per QALYs of BAHT360,108. The incremental cost-effectiveness ratio of providing the services to the prelingually deaf children was superior to the postlingually deaf adults because of the greater QALYs. Providing CI and rehabilitation for those two groups would cause substantial financial impact to the government. On the other hand, the numbers of health care professionals are currently inadequate which would affect the accessibility to CI. CONCLUSIONS: These findings would benefit to policy makers in considering whether to support CI under the public health care schemes in Thailand. However, the limited supply side capacity indicates that rationing is needed and the results suggest the prelingually deaf children should be given the highest priority based on the efficiency criteria.