title: Cochlear Implants Versus Hearing Aids in a Middle-Income Country: Costs, Productivity, and Quality of Life.
abstract: In Colombia there are three main treatment approaches for bilateral profound sensorineural hearing loss, also known as profound deafness (PD): cochlear implants (CI), hearing aids (HA), and no treatment (NT). The objective of this study is to determine the optimal treatment approach for PD in terms of productivity and cost-effectiveness.
  
  
  
  Hearing levels and SES data were obtained from audiometric tests conducted on 100 patients with CI. For each treatment approach, productivity and cost-effectiveness assessments were estimated using influence diagrams and Monte Carlo simulations. Productivity was calculated as the net present value of a patient's lifetime income divided by total health-related and educational costs. For the CI and HA, the cost-effectiveness indicator was calculated as quality-adjusted life-years (QALYs) gained in comparison with the NT approach divided by the total cost of the treatment option.
  
  
  
  The results for the CI, the HA, and NT in terms of productivity ratio were 1.53, 0.94, and 1.47, respectively. Patients using CI had a gain of 5.7 QALYs, whereas patients using HA had a gain of 4.6 QALYs. The results for the CI and the HA in terms of cost-effectiveness were $15,169 and $15,430 per QALY, respectively.
  
  
  
  The CI was found to be the optimal treatment for PD, as it was the most efficient and cost-effective in terms of improving patients' productivity and quality of life. We observed that children who had received CI developed hearing and speech abilities that contributed to their productivity and quality of life to a greater extent than those with HA.
authors.affiliation: *Department of Industrial Engineering, Universidad de los Andes, Bogota, Colombia †Cochlear Implants Group, Hospital Universitario Fundación Santa Fe de Bogota, School of Medicine, Universidad de los Andes ‡Postgraduate Program in Epidemiology, Center of Epidemiological Research, Universidade Federal de Pelotas, Pelotas, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Montes
authors.forename: Augusto
authors.initials: A
authors.lastname: Peñaranda
authors.forename: Santiago
authors.initials: S
authors.lastname: Correa
authors.forename: Daniel
authors.initials: D
authors.lastname: Peñaranda
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: García
authors.forename: Maria Leonor
authors.initials: ML
authors.lastname: Aparicio
authors.forename: Andrea Ramírez
authors.initials: AR
authors.lastname: Varela
authors.forename: Mario
authors.initials: M
authors.lastname: Castillo
mesh_terms: D002648:Child; D019929:Cochlear Implantation / Q000191:economics*; D003054:Cochlear Implants / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006310:Hearing Aids / Q000191:economics; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D019057:Quality-Adjusted Life Years; D013020:South America