National volume-based procurement for cochlear implants in China: lessons for improving access in LMICs

Cochlear implants (CIs) are the standard treatment for severe-to-profound sensorineural hearing loss. However, access to CIs remains limited in low- and middle-income countries (LMICs) due to high costs and market concentration. This study aims to evaluate the impact of China’s national volume-based procurement (NVBP) for CIs, implemented in December 2024, on reducing device prices and improving affordability. This study analyzed the participation of manufacturers in China’s NVBP for CIs and compared the mean list prices of CI systems and sound processors before and after the implementation of NVBP. Additionally, the estimated cost savings for the first 3-year procurement cycle were calculated. Five manufacturers participated, all of whom were selected for procurement. Before NVBP, the mean list prices were CNY 154,796 (USD 21,736) for a cochlear implant system and CNY 35,796 (USD 5,026) for a sound processor, respectively. Following NVBP, the mean prices fell to CNY 33,839 (USD 4,752) for a cochlear implant system and CNY 12,037 (USD 1,690) for a sound processor, representing an overall 76% reduction. Estimated cost savings for the first cycle were approximately CNY 2.8 billion (USD 393 million) for a 3-year procurement contract. NVBP can significantly enhance affordability and accessibility to high-cost medical devices. For LMICs, regional collaborations and joint procurement may help overcome market concentration and advance the WHO’s goal of universal hearing care by 2030. Cochlear implants remain inaccessible for most patients in LMICs due to high costs and market concentration. The NVBP design incorporated technical-feature-adjusted bid comparison, two-round bidding, and volume–price linkage, ensuring competition among multinational and domestic suppliers while maintaining clinical choice and quality. China’s NVBP policy for cochlear implants achieved an average price reduction of 76%, with an estimated cost-saving of CNY 2.8 billion (USD 393 million) for a 3-year procurement cycle. China’s experience offers a scalable model for other LMICs, suggesting that regional or multinational pooled procurement could overcome market concentration and advance the World Health Organisation (WHO)’s goal of universal hearing care by 2030.