- Design
- Lifetime Markov decision-analytic cost-effectiveness model, health system perspective, 5% discounting
- Population
- Chinese adults with severe or profound sensorineural hearing loss; inputs from six tertiary centres
- Primary outcome
- Incremental cost-effectiveness ratio versus hearing aids
- Effect
- 64,794.72 CNY per QALY (incremental cost 216,414 CNY, 3.34 QALYs gained), about 77% of GDP per capita
A lifetime Markov model built from six Chinese tertiary centres compared unilateral cochlear implantation with hearing aids in adults with severe or profound sensorineural hearing loss, from the health system's perspective, discounting costs and outcomes at 5 per cent a year and including surgery, rehabilitation, maintenance and periodic device replacement.
Implantation cost an extra 216,414 CNY and gained 3.34 quality-adjusted life years, giving an incremental cost-effectiveness ratio of 64,795 CNY per QALY — about 77 per cent of GDP per capita, well inside the WHO threshold of one to three times. Sensitivity and age-based scenario analyses held.
The relevance outside China is the structure of the argument rather than the numbers. Adult implantation is routinely under-funded in health systems that fund paediatric implantation, on the assumption that adults gain less. A model that includes device replacement and rehabilitation over a lifetime and still lands at three-quarters of GDP per capita is the form of evidence those funding decisions turn on.
- Adult candidacy assessment should not be limited by an assumption that implants are for children.
- Include replacement processors and lifelong rehabilitation when quoting cost to a patient or a payer.
- Model results depend on utility weights for hearing loss, which vary between populations.
- Indian cost structures differ — device pricing, surgical cost and rehabilitation availability all change the ratio.
- Cost-effectiveness is not affordability; the up-front cost remains a barrier at the household level.
Why it matters
It puts adult implantation on the same economic footing as the paediatric programmes that get funded.
Don't overread it
A model, not a trial: the output is only as good as the utility and cost inputs it was built from.
The statistics, in plain English
An incremental cost-effectiveness ratio is the extra cost divided by the extra benefit — here 216,414 CNY for 3.34 QALYs. Its credibility rests entirely on the model's assumptions: utility gain from implantation, device lifespan, complication rates and discount rate. The 5 per cent annual discount is higher than the 3 per cent often used, which works against implantation, so the result is not flattered on that count.
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