Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial

Yvette E. Smulders*, Alice van Zon, Inge Stegeman, Gijsbert A. van Zanten, Albert B. Rinia, Robert J. Stokroos, Rolien H. Free, Bert Maat, Johan H. M. Frijns, Emmanuel A. M. Mylanus, Wendy J. Huinck, Vedat Topsakal, Wilko Grolman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective:To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI.Study Design:Randomized controlled trial (RCT).Setting:Five tertiary referral centers.Patients:Thirty-eight postlingually deafened adults eligible for cochlear implantation.Interventions:A cost-utility analysis was performed from a health insurance perspective.Main Outcome Measures:Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy.Results:Direct costs for unilateral and bilateral CI were Euro43,883Euro11,513(SD) and Euro87,765 +/- Euro23,027(SD) respectively. Annual costs from the second year onward were Euro3,435 +/- Euro1,085(SD) and Euro6,871 +/- Euro2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing.Conclusion:This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer.
Original languageEnglish
Pages (from-to)38-45
JournalOtology & Neurotology
Issue number1
Publication statusPublished - Jan 2016


  • Bilateral cochlear implantation
  • Cochlear implant
  • Cost-effectiveness
  • Cost-utility
  • Deafness
  • Hearing loss


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