COCHLEAR IMPLANTS
Imagawa, Norie∗,†,‡; Izumi, Shuji§; Shimazaki, Takashi†; Yamauchi, Takashi†; Ikeda, Shunya¶; Noto, Shinichi∥; Kojima, Hiromi‡; Suka, Machi†
∗Department of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
†Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
‡Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan
§Department of Otolaryngology, Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
¶Department of Pharmaceutical Sciences, School of Pharmacy, International University of Health and Welfare, Tochigi, Japan
∥Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
Address correspondence and reprint requests to: Norie Imagawa, M.S., Department of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan; E-mail: [emailprotected]
Sources of support and disclosure of funding: This research was supported by grants from The Jikei University Research Fund for Graduate Students: 2022 DC0189. The funding organization had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the decision to submit the article for publication; or in the preparation, review, or approval of the article.
Ethics approval: The study protocol was approved by the Ethics Committee of the Jikei University School of Medicine (reference number 35-089 [11714]) and has been conducted in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects by the Japanese Government.
Author statement: In this study, the data of some cochlear implant users at Facility 1 were previously reported in a study on the general quality of life of cochlear implant users 60 years and older (Imagawa et al. 2024).
Author contribution statements: Norie Imagawa designed and performed experiments, analyzed data, and wrote the paper. Takashi Shimazaki, Takashi Yamauchi, and Machi Suka designed and performed experiments at the facility1 in Japan. Suka Machi provided statistical analysis and critical revision. Shuji Izumi collected data from the facility2 in Japan.
All authors contributed equally to this work. Shunya Ikeda, Shinichi Noto, and Hiromi Kojima reviewed data from all sites and provided interpretive analysis.
All authors discussed the results and implications and commented on the manuscript at all stages.
Supplemental digital content is available in the text.
Otology & Neurotology 46(6):p 634-640, July 2025. | DOI: 10.1097/MAO.0000000000004504
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Abstract
Objectives
This study aimed to evaluate the cost-effectiveness of cochlear implants in older adults with hearing impairment 65 years or older in Japan. In addition, this study aimed to establish a basis for making recommendations for cochlear implants in clinical practice for suitable patients.
Design
We conducted a cost-utility analysis using the incremental cost-effectiveness ratio (ICER) to compare unilateral cochlear implants with hearing aids. The study involved participants 65 years or older with severe-to-profound hearing loss attending two cochlear implant surgery facilities in Japan. Costs were calculated from the participants' receipt data and standard clinical paths from medical care providers. Quality-adjusted life years (QALY) were assessed by patients using the Japanese version of the Health Utilities Index Mark 3 and by medical care providers using the visual analog scale (VAS). In addition, sensitivity analyses were performed by varying the utility value, discount rate, age at implantation, and costs to estimate the ICER under different scenarios.
Results
Responses were received from 26 cochlear implant users and 8 hearing aid users. After applying the survival and discount rates to the utility values and costs, the ICER was $44,533, which falls within the acceptable willingness-to-pay threshold in Japan. Sensitivity analysis showed that the ICER was the most sensitive to the utility value, followed by the discount rate.
Conclusions
The findings indicate that providing cochlear implants to older adults with hearing impairment is not only beneficial in terms of improved hearing performance but also economically efficient.
