Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Strada di Fiume 447, 34129, Trieste, Italy.
Department of Economic, Business, Mathematical and Statistical Sciences 'Bruno de 'Finetti', University of Trieste, Trieste, Italy.
Eur Arch Otorhinolaryngol. 2024 Sep;281(9):4455-4471. doi: 10.1007/s00405-024-08591-3. Epub 2024 Mar 23.
The aim of this study was to provide an updated European narrative review spanning the last decade, focusing on the cost-effectiveness of cochlear implants (CIs) for adults with severe to profound post-lingual hearing loss.
This review encompasses both prospective and retrospective approaches, as well as cross-sectional and longitudinal trials conducted on CIs in adults. All studies related to European countries (Austria, Germany, Switzerland, the Netherlands, Sweden, the UK and Poland) were conducted in English and were published between 2012 and June 2023.
Nine studies were included in the analysis. The patients' ages ranged from 18 years to over 67 years, with sample sizes ranging from 20 to 100 patients; two of these studies were focused on single-sided deafness in adults. The Markov model was identified as the most commonly utilized analysis method.
This review identified a general consensus on CI cost-effectiveness, despite substantial variability among countries in factors such as observation time horizons, cost-effectiveness thresholds, methods of cost collection, discount rates, CI eligibility criteria and country-specific health systems. Generally, CIs yield positive societal benefits for working-age individuals, potentially less for seniors. Early unilateral CI enhances cost-effectiveness, highlighting the importance of prompt candidate identification. A consistent undersupply of CIs relative to the percentage of potential recipients emerged across countries. Therefore, further investigation into subcategories such as single-sided deafness is warranted, along with country-specific cost analyses. Emphasizing the significance of detailed information on health systems and associated costs and benefits is crucial for facilitating comparisons across different settings.
本研究旨在提供一份涵盖过去十年的欧洲叙事性综述，重点关注成人重度至极重度后天性听力损失患者使用人工耳蜗（CI）的成本效益。
本综述涵盖了前瞻性和回顾性方法，以及在成人中进行的横断面和纵向 CI 试验。所有与欧洲国家（奥地利、德国、瑞士、荷兰、瑞典、英国和波兰）相关的研究均以英文进行，并于 2012 年至 2023 年 6 月期间发表。
共纳入 9 项研究进行分析。患者年龄从 18 岁到 67 岁以上不等，样本量从 20 例到 100 例不等；其中两项研究针对成人单侧耳聋。Markov 模型被确定为最常用的分析方法。
尽管各国在观察时间范围、成本效益阈值、成本收集方法、贴现率、CI 资格标准和特定国家的卫生系统等因素方面存在很大差异，但本综述确定了 CI 成本效益的总体共识。一般来说，CI 对工作年龄段的个体具有积极的社会效益，对老年人的效益可能较小。早期单侧 CI 提高了成本效益，突出了及时确定候选者的重要性。各国都存在 CI 相对潜在受助者比例供应不足的情况。因此，有必要对单侧耳聋等亚组进行进一步研究，并进行特定国家的成本分析。强调详细了解卫生系统以及相关成本和效益的重要性，有助于促进不同环境下的比较。
