Cost-Utility of the Cochlear Implant in AdultsA Meta-analysis

OBJECTIVE: To conduct a meta-analysis of the cost-utility of the cochlear implant in adults. DATA SOURCES: MEDLINE literature search, review of article bibliographies, and consultation with experts. STUDY SELECTION: 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). DATA EXTRACTION: 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. DATA SYNTHESIS: 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.