Cost-utility of the cochlear implant in adults: a meta-analysis.
OBJECTIVE
To conduct a meta-analysis of the cost-utility of the cochlear implant in adults.


METHODS
MEDLINE literature search, review of article bibliographies, and consultation with experts.


METHODS
Studies that reported (1) data on adults (age > or = 18 years) with bilateral, postlingual, profound deafness; (2) a health-utility gain from cochlear implantation on a scale from 0.00 (death) to 1.00 (perfect health); (3) a cost-utility ratio in terms of dollars per quality-adjusted life-year (QALY); and (4) at least 1 conventional statistical parameter (ie, SD, 95% confidence interval [CI], or P value).


METHODS
From each study, we extracted the number of subjects, study design, health-utility instrument used, health-utility associated with profound deafness, health-utility gain from cochlear implantation, cost-utility of cochlear implantation, and reported statistical parameters.


RESULTS
Weighted averages were calculated using a statistical weight of 1 per variance. Pooling 9 reports (n = 619), the health-utility of profoundly deaf adults without cochlear implants was 0.54 (95% CI, 0.52-0.56). Pooling 7 studies (n = 511), the health-utility of profoundly deaf adults after cochlear implantation was 0.80 (95% CI, 0.78-0.82). This improvement of 0.26 in health-utility resulted in a cost-utility ratio of $12,787 per QALY.


CONCLUSIONS
Profound deafness in adults results in a substantial health-utility loss. Over half of that loss is restored after cochlear implantation, yielding a cost-utility ratio of $12,787 per QALY. This figure compares favorably with medical and surgical interventions that are commonly covered by third-party payers in the United States today.
Cheng
A K
AK
Listening Center, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21203-6402, USA.
Niparko
J K
JK
D000328:Adult; D019929:Cochlear Implantation / Q000191:economics*; D003054:Cochlear Implants / Q000191:economics*; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003638:Deafness / Q000534:rehabilitation / Q000601:surgery; D006304:Health Status; D006801:Humans; D007349:Insurance, Health, Reimbursement; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States