Incerti Paola Vittoria, Pang Jermy, Gavrilis Jason, Zhang Vicky W, Tsiolkas Jessica, Sharma Rajan, Seil Elizabeth, Ahumada-Canale Antonio, Parkinson Bonny, Kitterick Padraig Thomas
National Acoustic Laboratories, Macquarie University, Sydney, NSW 2109, Australia.
Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW 2109, Australia.
J Clin Med. 2025 May 28;14(11):3765. doi: 10.3390/jcm14113765.
Many older Australian adults with cochlear implants (CI) lack funding for replacement sound processors, risking complete device failure and reduced quality of life. The need for replacement CI devices for individuals with obsolete sound processors and no access to funding poses an increasing public health challenge in Australia and worldwide. We aimed to investigate the clinical and cost-effectiveness of upgrading obsolete CI sound processors in older adults. Alongside an Australian Government-funded upgrade program, a prospective, mixed-methodology design study was undertaken. Participants were aged 65 and over, with obsolete Cochlear™ sound processors and no funding for replacements. This study compared speech perception in noise, as well as self-reported outcome measures, including cognition, listening effort, fatigue, device benefit, mental well-being, participation, empowerment and user experiences, between upgraded and obsolete hearing aid processors. The economic impact of the upgrade was evaluated using two state-transition microsimulation models of adults using CIs. The multi-site study ran from 20 May 2021 to 21 April 2023, with recruitment from June 2021 to May 2022. A total of 340 Cochlear™ sound processors were upgraded in 304 adults. The adults' mean age was 77.4 years (SD 6.6), and 48.5% were female. Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech understanding in noise and reduced communication difficulties, self-reported listening effort and fatigue. Semi-structured interviews have revealed that upgrades alleviated the anxiety and fear of sudden processor failure. Health economic analysis found that the cost-effectiveness of upgrades stemmed from preventing device failures, rather than from access to newer technology features. Our study identified significant clinical and self-reported benefits from upgrading Cochlear™ sound processors. Economic value came from avoiding scenarios where a total failure of device renders its user unable to access sound. The evidence gathered can be used to inform policy on CI processor upgrades for older adults.
许多植入人工耳蜗（CI）的澳大利亚老年成年人缺乏更换声音处理器的资金，这有导致设备完全故障和生活质量下降的风险。对于那些声音处理器过时且无法获得资金来更换CI设备的个人来说，更换需求在澳大利亚乃至全球都构成了日益严峻的公共卫生挑战。我们旨在调查升级老年成年人过时的CI声音处理器的临床效果和成本效益。除了一项由澳大利亚政府资助的升级计划外，还开展了一项前瞻性、混合方法设计的研究。参与者年龄在65岁及以上，使用的是过时的科利耳（Cochlear™）声音处理器且没有更换资金。本研究比较了升级后的和过时的助听器处理器在噪声环境下的言语感知，以及自我报告的结果指标，包括认知、聆听努力程度、疲劳、设备效益、心理健康、参与度、自主感和用户体验。使用两个关于使用CI的成年人的状态转换微观模拟模型评估了升级的经济影响。这项多地点研究从2021年5月20日持续到2023年4月21日，招募工作从2021年6月持续到2022年5月。共有304名成年人的340个科利耳（Cochlear™）声音处理器得到了升级。这些成年人的平均年龄为77.4岁（标准差6.6），48.5%为女性。听力损失平均始于30岁（标准差21.0），使用CI的时间为12年（标准差6.2）。结果显示，在噪声环境下的言语理解有显著改善，沟通困难、自我报告的聆听努力程度和疲劳感都有所减轻。半结构化访谈表明，升级缓解了对处理器突然故障的焦虑和恐惧。健康经济分析发现，升级的成本效益源于预防设备故障，而非获得更新的技术功能。我们的研究确定了升级科利耳（Cochlear™）声音处理器带来的显著临床益处和自我报告的益处。经济价值来自于避免设备完全故障导致用户无法听到声音的情况。所收集的证据可用于为有关老年成年人CI处理器升级的政策提供参考。
