Authors' objectives: This health technology assessment looked at the effectiveness, safety, and cost-effectiveness of cochlear implants and bone-conduction implants for adults and children with single-sided deafness and the use of bone-conduction implants for adults and children with conductive or mixed hearing loss.It also looked at the budget impact of publicly funding these implantable devices, as well as the preferences, values, and experiences of people with single-sided deafness, conductive hearing loss,or mixed hearing loss.

Authors' results and conclusions: Based on evidence of moderate quality from systematic reviews of clinical studies, cochlear implants and bone-conduction implants improve functional and patient-important outcomes in adults and children with single-sided deafness and conductive or mixed hearing loss. We did not identify any cost-effectiveness studies in the literature that were directly applicable to our research questions. Among people with single-sided deafness, cochlear implants may be cost-effective compared with no intervention, but bone-conduction implants are unlikely to be. Among people with conductive or mixed hearing loss, bone-conduction implants may be cost-effective compared with no intervention. Results and uncertainty are mainly driven by changes in health utilities associated with having a hearing implant. Further research on health-related quality of life is warranted, with larger sample sizes and longer follow-up. We estimate that publicly funding cochlear and bone-conduction implants as indicated for people with single-sided deafness and conductive or mixed hearing loss would cost Ontario approximately $6.7million to $7.8million in total over the next 5 years. Hearing implants for single-sided deafness account about half of this budget impact ($2.8million to $3.6million for cochlear implants and an additional $0.8 million for bone-conduction implants). Bone-conduction implants for conductive or mixed hearing loss account for the remaining 5-year budget impact ($3.1 million to $3.3 million). In interviews,people with single-sided deafness or conductive or mixed hearing loss reported that the currently available treatments did not meet their expectations and therefore they chose to undergo surgery for an implantable device. Despite describing some limitations to the devices, most participants with experience of either a cochlear implant or bone-conduction implant spoke positively about being able to hear better and enjoy a better quality of life. People with a cochlear implant reported additional benefits: binaural hearing, better sound localization, and better hearing in noisy areas. Cost and access were important barriers to receiving a hearing implant.

Authors' recommendations: The Quality business unit at Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends publicly funding: Cochlear implantation for adults and children with single-sided deafness Bone-conduction implantable devices for adults and children with single-sided deafness who have a contraindication to cochlear implantation Bone-conduction implantable devices for adults and children with conductive or mixed hearing loss

Authors' methods: We conducted a health technology assessment, which included an evaluation of clinical benefits and harms, cost-effectiveness, budget impact, and patient preferences and values related to implantable devices for single-sided deafness and conductive or mixed hearing loss. We performed a systematic literature search for systematic reviews and cost-effectiveness studies of cochlear implants and bone-conduction implants, compared to no interventions, for these conditions in adults and children. We conducted cost–utility analyses and budget impact analyses from the perspective of the Ontario Ministry of Health to examine the impact of publicly funding both types of hearing implants for the defined populations. We also interviewed 22 patients and parents of children about their experience with hearing loss and hearing implants.

Project Status: Completed

URL for project: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Journal-Ontario-Health-Technology-Assessment-Series

URL for protocol: Unpublished

Year Published: 2020

URL for published report: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Journal-Ontario-Health-Technology-Assessment-Series

Requestor: Ontario Health Technology Advisory Committee (OHTAC); Ontario Ministry of Health

URL for additional information: https://www.hqontario.ca/evidence-to-improve-care/health-technology-assessment/reviews-and-recommendations/implantable-devices-for-single-sided-deafness-and-conductive-or-mixed-hearing-loss

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Ontario

Pubmed ID: 32194878

Organisation Name: Ontario Health

Contact Address: 525 University Ave, Toronto, ON M5G 2L3

Contact Name: Nancy Sikich, Director Health Technology Assessment

Contact Email: oh-hqo_hta@ontariohealth.ca

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