Cost-effectiveness of Pediatric Unilateral/Bilateral Cochlear Implant in a Developing Country

Objective: To determine the cost-effectiveness of unilateral and bilateral cochlear implantation (CI) for children suffering from bilateral profound SNHL. Study Design: This was a cost benefit analysis study where quality-adjusted life years (QALY) and the expenditure involved post unilateral and bilateral CI were calculated to assess the cost per QALY gained. Setting: The study was conducted in a tertiary-care hospital in a city of a developing country. Patients: A total of 59 patients were studied during the years 2015 to 2019 of which a study cohort of 29 patients underwent bilateral cochlear implantation and a control cohort of 30 patients received U/L CI but did not undergo B/L CI. Main Outcome: The QALY parameters HUI3 and VAS when patient had no implant, post unilateral and bilateral CI were calculated along with the total lifelong expenditure involved. The outcomes improvement post CI was compared in the study and control groups. The discounted net cost per QALY gained was assessed and compared with the PCGDP of the country for cost effectiveness. Results: Significant QALY was gained post unilateral and bilateral CI and the expenditure for both was within the cost thresholds. The net costs per QALY gained post the discounting in unilateral and bilateral CI were found to be 1,345 US$ and 1,977 US$ respectively. The PCGDP (nominal) of India in 2018 was 2,016 US$. The cost involved per QALY gained was found to be lesser than the per capita GDP of India. Conclusion: Unilateral CI was found to be highly cost effective with bilateral CI involving a little higher cost per QALY gained but well within the cost effectiveness threshold.