title: Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI.
  
  
  METHODS
  Randomized controlled trial (RCT).
  
  
  METHODS
  Five tertiary referral centers.
  
  
  METHODS
  Thirty-eight postlingually deafened adults eligible for cochlear implantation.
  
  
  METHODS
  A cost-utility analysis was performed from a health insurance perspective.
  
  
  METHODS
  Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy.
  
  
  RESULTS
  Direct costs for unilateral and bilateral CI were €43,883 ± €11,513(SD) and €87,765 ± €23,027(SD) respectively. Annual costs from the second year onward were €3,435 ± €1,085(SD) and €6,871 ± €2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing.
  
  
  CONCLUSIONS
  This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.
authors.affiliation: *Department of Otorhinolaryngology, Head and Neck Surgery†Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht‡Department of Otorhinolaryngology, Isalaklinieken, Zwolle§Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht||Department of Otorhinolaryngology¶Graduate School of Medical Sciences, Research School of Behavioral and Cognitive Neurosciences, University Medical Center Groningen, Groningen#Department of Otorhinolaryngology, Head and Neck Surgery**Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden††Department of Otorhinolaryngology, Head and Neck Surgery‡‡Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Yvette E
authors.initials: YE
authors.lastname: Smulders
authors.forename: Alice
authors.initials: A
authors.lastname: van Zon
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
authors.forename: Gijsbert A
authors.initials: GA
authors.lastname: van Zanten
authors.forename: Albert B
authors.initials: AB
authors.lastname: Rinia
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stokroos
authors.forename: Rolien H
authors.initials: RH
authors.lastname: Free
authors.forename: Bert
authors.initials: B
authors.lastname: Maat
authors.forename: Johan H M
authors.initials: JH
authors.lastname: Frijns
authors.forename: Emmanuel A M
authors.initials: EA
authors.lastname: Mylanus
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Huinck
authors.forename: Vedat
authors.initials: V
authors.lastname: Topsakal
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019929:Cochlear Implantation / Q000191:economics*; D003054:Cochlear Implants / Q000191:economics*; D003362:Cost-Benefit Analysis; D003638:Deafness / Q000191:economics / Q000628:therapy; D005260:Female; D007839:Functional Laterality; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D055815:Young Adult