Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jul;26(5):735-744.
doi: 10.1007/s10198-024-01740-9. Epub 2024 Nov 20.

Cost-utility of cochlear implantation in single-sided deafness and asymmetric hearing loss: results of a randomized controlled trial

Mathieu Marx  1   2 , Michaël Mounié  3 , Isabelle Mosnier  4   5 , Frédéric Venail  6 , Michel Mondain  6 , Alain Uziel  6 , David Bakhos  7 , Emmanuel Lescanne  7 , Yann N'Guyen  4   5 , Daniele Bernardeschi  4   5 , Olivier Sterkers  4   5 , Benoit Godey  8 , Gwenaëlle Creff  8 , Sébastien Schmerber  9 , Nicolas-Xavier Bonne  10 , Christophe Vincent  11 , Bernard Fraysse  12 , Olivier Deguine  12   13 , Nadège Costa  3
Affiliations
Randomized Controlled Trial

Cost-utility of cochlear implantation in single-sided deafness and asymmetric hearing loss: results of a randomized controlled trial

Mathieu Marx et al. Eur J Health Econ. 2025 Jul.

Abstract

Objectives: To determine the Incremental Cost-Utility Ratio (ICUR) of cochlear implantation in the treatment of adult patients with single-sided deafness (SSD) and asymmetric hearing loss (AHL).

Methods: This prospective multicenter pragmatic study including a randomized controlled trial (RCT) enrolled 155 subjects with SSD or AHL. Subjects chose a treatment option between: abstention, Contralateral Routing Of the Signal hearing aids, Bone Conduction Device or Cochlear Implant (CI). Participants who opted for CI were then randomized between two arms: "immediate CI" where the cochlear implantation was performed within one month and "initial observation" where subjects were first observed. The ICUR of CI was determined at 6 months follow-up by comparing the two arms. Utility was measured using EuroQoL- 5 dimensions (EQ-5D), to calculate the gain in Quality-Adjusted Life Years (QALY). Individual costs were extracted from the French National Health Insurance database. A Markovian MultiState (MMS) model assessed the ICUR evolution over the lifetime horizon.

Results: Among the 155 included participants, 51 opted for a CI and were randomized. For a 6 months follow-up period, the ICUR was €422,279/QALY gained after CI. Using the MMS model, the ICUR of CI decreased to €57,561/QALY at 10 years follow-up, €38,006/QALY at 20 years, and dropped to €26,715 at 50 years. In the participants with severe tinnitus, mean ICUR was €31,105/QALY at 10 years.

Conclusions: CI can be considered as an efficient treatment in SSD and AHL from 20 years follow-up in the global population, and before 10 years follow-up in patients with severe associated tinnitus.

Keywords: Asymmetric hearing loss; Cochlear implant; ICUR; Single-sided deafness; Tinnitus.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Multistatus Markovian model used to model lifetime evolution of the Incremental Cost-Utility Ratio of cochlear implant
Fig. 2
Fig. 2
Confidence ellipses for ICUR at different follow-up intervals
Fig. 3
Fig. 3
Acceptability curves at 20 years follow-up for all simulated subjects, or divided according to the presence or absence of a severe associated tinnitus (VAS > 6/10)
See this image and copyright information in PMC

References

    1. Zeng, F.G.: Celebrating the one millionth cochlear implant. JASA Express Lett. 2(7), 077201 (2022). 10.1121/10.0012825 - PubMed
    1. Borre, E.D., Kaalund, K., Frisco, N., Zhang, G., Ayer, A., Kelly-Hedrick, M., Reed, S.D., Emmett, S.D., Francis, H., Tucci, D.L., Wilson, B.S., Kosinski, A.S., Ogbuoji, O., Sanders Schmidler, G.D.: The impact of hearing loss and its treatment on Health-Related Quality of Life Utility: A systematic review with Meta-analysis. J. Gen. Intern. Med. 38(2), 456–479 (2023). 10.1007/s11606-022-07795-9 - PMC - PubMed
    1. Brodie, A., Smith, B., Ray, J.: The impact of rehabilitation on quality of life after hearing loss: A systematic review. Eur. Arch. Otorhinolaryngol. 275(10), 2435–2440 (2018). 10.1007/s00405-018-5100-7 - PMC - PubMed
    1. UK Cochlear Implant Study Group: Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults II: Cost-effectiveness analysis. Ear Hear. 25(4), 336–360 (2004). 10.1097/01.aud.0000134550.80305.04 - PubMed
    1. Cheng, A.K., Rubin, H.R., Powe, N.R., Mellon, N.K., Francis, H.W., Niparko, J.K.: Cost-utility analysis of the cochlear implant in children. JAMA. 284(7), 850–856 (2000). 10.1001/jama.284.7.850 - PubMed

Publication types

LinkOut - more resources