The Evaluation of the Effects of Cochlear Implant Treatment on Quality of Life and Costs: A Systematic Review
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Abstract
Background: We aimed to systematically examine the effects of Cochlear Implant Treatment (CIT) on quality of life and costs and to raise awareness of its economic and clinical value.
Methods: A systematic scan was conducted for relevant published studies over Google Scholar, PubMed, ScienceDirect, Springer Link, and Web of Science electronic databases. The search covered studies published between January 2009 and December 2024. Literature search and data extraction were conducted by two researchers and the Drummond Checklist was used to assess the risk of bias and applicability of the included literature. The study was conducted following the PRISMA-2020 guidelines.
Results: Overall, 11 studies were included in the study. When these studies were evaluated, it was found that most of them were conducted in 2021, children were the most preferred sample group, and these studies focused on unilateral Cochlear Implant Treatment. The lowest quality of life value was 0.452 and the highest was 0.93. Cost-effectiveness analyses were used in the studies to determine the cost-effectiveness of cochlear implants, and the Markov Model was preferred. The Incremental Cost-Effectiveness Ratio (ICER) was employed as the outcome measure highly cost-effective in lower-income settings such as Taiwan, while higher ICER values were observed in high-income countries such as the USA.
Conclusion: Cochlear implant treatment improves quality of life and is generally cost-effective for both children and adults, as supported by the majority of studies.
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2. Dror AA, Avraham KB (2010). Hearing im-pairment: a panoply of genes and func-tions. Neuron, 68 (2): 293–308.
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11. Karaçam Z (2013). Systematic review meth-odology: a guide for preparing a sys-tematic review. DEU J Nurs, 6(1): 26–33.
12. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. (2021). PRISMA 2020 explanation and elabora-tion: updated guidance and exemplars for reporting systematic reviews. BMJ, 372: 160.
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15. Edmunds K, Ling R, Shakeshaft A, Doran C, Searles A (2018). Systematic review of economic evaluations of interventions for high-risk young people. BMC Health Serv Res, 18 (1): 660.
16. Drummond MF, Jefferson T (1996). Guide-lines for authors and peer reviewers of economic submissions to the BMJ. BMJ, 313 (7052): 275.
17. Cheng LJ, Soon SS, Wu DBC, Ju H, Ng K (2019). Cost-effectiveness analysis of bi-lateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore. PLoS One, 14 (8).
18. Cutler H, Gumbie M, Olin E, Parkinson B, Bowman R, Quadri H, et al. (2022). The cost-effectiveness of unilateral cochlear implants in UK adults. Eur J Health Econ, 23 (5): 763–779.
19. Dreyfuss M, Giat Y, Veraguth D, Röösli C, Huber AM, Laske RD (2021). Cost effec-tiveness of cochlear implantation in single-sided deafness. Otol Neurotol, 42 (8): 1129–1135.
20. Fang TY, Cheng LJ, Wu DBC, Wang PC (2020). Cost-effective analysis of unilat-eral cochlear implantation under the Taiwan national healthcare insurance. Int J Audiol, 59 (1): 39–44.
21. Foteff C, Kennedy S, Milton AH, Deger M, Payk F, Sanderson G (2016). Cost–utility analysis of cochlear implantation in Australian adults. Otol Neurotol, 37b (5): 454–461.
22. Gumbie M, Olin E, Parkinson B, Bowman R, Cutler H (2021). The cost-effectiveness of cochlear implants in Swedish adults. BMC Health Serv Res, 21 (1): 319.
23. Laske RD, Dreyfuss M, Stulman A, Veraguth D, Huber AM, Röösli C (2019). Age dependent cost-effectiveness of cochlear implantation in adults. Otol Neurotol, 40 (7): 892–899.
24. Qiu J, Yu C, Ariyaratne TV, Foteff C, Ke Z, Sun Y, et al. (2017). Cost-effectiveness of pediatric cochlear implantation in rural China. Otol Neurotol, 38 (6): 75–84.
25. Pérez-Martín J, Artaso MA, Díez FJ (2017). Cost-effectiveness of pediatric bilateral cochlear implantation in Spain. Laryngo-scope, 127 (12): 2866–2872.
26. Saunders JE, Barrs DM, Gong W, Wilson BS, Mojica K, Tucci DL (2015). Cost ef-fectiveness of childhood cochlear im-plantation and deaf education in Nica-ragua: a disability adjusted life year model. Otol Neurotol, 36 (8): 1349–1356.
27. Summerfield AQ, Lovett RE, Bellenger H, Batten G (2010). Estimates of the cost-effectiveness of pediatric bilateral coch-lear implantation. Ear Hear, 31 (5): 611–624.
28. Wilson BS, Tucci DL, Merson MH, O’Donoghue GM (2017). Global hearing health care: new findings and perspec-tives. Lancet, 390 (10111): 2503–2515.
29. Cuda D, Manrique M, Ramos Á, Marx M, Bovo R, Khnifes R, et al. (2024). Improv-ing quality of life in the elderly: hearing loss treatment with cochlear implants. BMC Geriatr, 24 (1): 16.
30. Bukhari AF, Zawawi F (2024). The impact of hearing loss and cochlear implanta-tion on the quality of life in children. Int J Pediatr Otorhinolaryngol, 184: 112069.
31. Fan S, Zhang C, Chen M, Mao J, Li S (2024). The impact of cochlear implantation on quality of life and psychological status in single-sided deafness or asymmetric hearing loss. Eur Arch Otorhinolaryngol, 281 (1): 95–105.
32. Gatto A, Tofanelli M, Valentinuz G, Mascherin A, Costariol L, Rizzo S, et al. (2024). Cochlear implant cost analysis in adults: a European narrative review. Eur Arch Otorhinolaryngol, 281 (9): 4455–4471.
33. Crathorne L, Bond M, Cooper C, Elston J, Weiner G, Taylor RS, et al. (2012). A sys-tematic review of the effectiveness and cost-effectiveness of bilateral multi-channel cochlear implants in adults. Clin Otolaryngol, 37 (5): 342–354.
34. Bond M, Mealing S, Anderson R, Elston J, Weiner G, Taylor RS, et al. (2009). The effectiveness and cost-effectiveness of cochlear implants for severe to pro-found deafness. Health Technol Assess, 13 (44): 1–330.
2. Dror AA, Avraham KB (2010). Hearing im-pairment: a panoply of genes and func-tions. Neuron, 68 (2): 293–308.
3. Cunningham LL, Tucci DL (2017). Hearing loss in adults. N Engl J Med, 377 (25): 2465–2473.
4. Kushalnagar R (2019). Deafness and hear-ing loss. In: Web Accessibility: A Foundation for Research. 35–47.
5. Nieman CL, Oh ES (2020). Hearing loss. Ann Intern Med, 173 (11): 81-96.
6. Crowson MG, Semenov YR, Tucci DL, Niparko JK (2018). Quality of life and cost-effectiveness of cochlear implants: a narrative review. Audiol Neurotol, 22 (4–5): 236–258.
7. Kirtane MV, Mankekar G, Mohandas N, Patadia R (2010). Cochlear implants. Int J Otorhinolaryngol Clin, 2 (2): 133–137.
8. Tjellström A, Håkansson BO, Granström G (2001). Bone-anchored hearing aids: current status in adults and children. Oto-laryngol Clin North Am, 34 (2): 337–364.
9. Tatar M, Wertheimer AI (2010). Assessment of health technologies—A Model Proposal for Drug Reimbursement Decisions. MN Medikal & Nobel Printing Publishing.
10. Rudmik L, Drummond M (2013). Health economic evaluation: important princi-ples and methodology. Laryngoscope, 123 (6): 1341–1347.
11. Karaçam Z (2013). Systematic review meth-odology: a guide for preparing a sys-tematic review. DEU J Nurs, 6(1): 26–33.
12. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. (2021). PRISMA 2020 explanation and elabora-tion: updated guidance and exemplars for reporting systematic reviews. BMJ, 372: 160.
13. PROSPERO (2025). International Prospective Register of Systematic Reviews. Available from: https://www.crd.york.ac.uk/prospero/
14. Çınar N (2021). How to write a good sys-tematic review? Online Turk J Health Sci, 6 (2): 310–314.
15. Edmunds K, Ling R, Shakeshaft A, Doran C, Searles A (2018). Systematic review of economic evaluations of interventions for high-risk young people. BMC Health Serv Res, 18 (1): 660.
16. Drummond MF, Jefferson T (1996). Guide-lines for authors and peer reviewers of economic submissions to the BMJ. BMJ, 313 (7052): 275.
17. Cheng LJ, Soon SS, Wu DBC, Ju H, Ng K (2019). Cost-effectiveness analysis of bi-lateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore. PLoS One, 14 (8).
18. Cutler H, Gumbie M, Olin E, Parkinson B, Bowman R, Quadri H, et al. (2022). The cost-effectiveness of unilateral cochlear implants in UK adults. Eur J Health Econ, 23 (5): 763–779.
19. Dreyfuss M, Giat Y, Veraguth D, Röösli C, Huber AM, Laske RD (2021). Cost effec-tiveness of cochlear implantation in single-sided deafness. Otol Neurotol, 42 (8): 1129–1135.
20. Fang TY, Cheng LJ, Wu DBC, Wang PC (2020). Cost-effective analysis of unilat-eral cochlear implantation under the Taiwan national healthcare insurance. Int J Audiol, 59 (1): 39–44.
21. Foteff C, Kennedy S, Milton AH, Deger M, Payk F, Sanderson G (2016). Cost–utility analysis of cochlear implantation in Australian adults. Otol Neurotol, 37b (5): 454–461.
22. Gumbie M, Olin E, Parkinson B, Bowman R, Cutler H (2021). The cost-effectiveness of cochlear implants in Swedish adults. BMC Health Serv Res, 21 (1): 319.
23. Laske RD, Dreyfuss M, Stulman A, Veraguth D, Huber AM, Röösli C (2019). Age dependent cost-effectiveness of cochlear implantation in adults. Otol Neurotol, 40 (7): 892–899.
24. Qiu J, Yu C, Ariyaratne TV, Foteff C, Ke Z, Sun Y, et al. (2017). Cost-effectiveness of pediatric cochlear implantation in rural China. Otol Neurotol, 38 (6): 75–84.
25. Pérez-Martín J, Artaso MA, Díez FJ (2017). Cost-effectiveness of pediatric bilateral cochlear implantation in Spain. Laryngo-scope, 127 (12): 2866–2872.
26. Saunders JE, Barrs DM, Gong W, Wilson BS, Mojica K, Tucci DL (2015). Cost ef-fectiveness of childhood cochlear im-plantation and deaf education in Nica-ragua: a disability adjusted life year model. Otol Neurotol, 36 (8): 1349–1356.
27. Summerfield AQ, Lovett RE, Bellenger H, Batten G (2010). Estimates of the cost-effectiveness of pediatric bilateral coch-lear implantation. Ear Hear, 31 (5): 611–624.
28. Wilson BS, Tucci DL, Merson MH, O’Donoghue GM (2017). Global hearing health care: new findings and perspec-tives. Lancet, 390 (10111): 2503–2515.
29. Cuda D, Manrique M, Ramos Á, Marx M, Bovo R, Khnifes R, et al. (2024). Improv-ing quality of life in the elderly: hearing loss treatment with cochlear implants. BMC Geriatr, 24 (1): 16.
30. Bukhari AF, Zawawi F (2024). The impact of hearing loss and cochlear implanta-tion on the quality of life in children. Int J Pediatr Otorhinolaryngol, 184: 112069.
31. Fan S, Zhang C, Chen M, Mao J, Li S (2024). The impact of cochlear implantation on quality of life and psychological status in single-sided deafness or asymmetric hearing loss. Eur Arch Otorhinolaryngol, 281 (1): 95–105.
32. Gatto A, Tofanelli M, Valentinuz G, Mascherin A, Costariol L, Rizzo S, et al. (2024). Cochlear implant cost analysis in adults: a European narrative review. Eur Arch Otorhinolaryngol, 281 (9): 4455–4471.
33. Crathorne L, Bond M, Cooper C, Elston J, Weiner G, Taylor RS, et al. (2012). A sys-tematic review of the effectiveness and cost-effectiveness of bilateral multi-channel cochlear implants in adults. Clin Otolaryngol, 37 (5): 342–354.
34. Bond M, Mealing S, Anderson R, Elston J, Weiner G, Taylor RS, et al. (2009). The effectiveness and cost-effectiveness of cochlear implants for severe to pro-found deafness. Health Technol Assess, 13 (44): 1–330.
| Files | ||
| Issue | Vol 55 No 1 (2026) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v55i1.20972 | |
| Keywords | ||
| Hearing loss Cochlear implant Quality of life Cost-effectiveness Systematic review | ||
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How to Cite
1.
Koçaş M, Yiğit A. The Evaluation of the Effects of Cochlear Implant Treatment on Quality of Life and Costs: A Systematic Review. Iran J Public Health. 2026;55(1):53-62.
