{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T03:54:00Z","timestamp":1789444440222,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,1,15]],"date-time":"2014-01-15T00:00:00Z","timestamp":1389744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>To determine the cost\u2010effectiveness of bilateral cochlear implantation (CI) in deaf adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Cost\u2013utility analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ninety patients and 52 health professionals served as proxies to estimate the benefit of bilateral cochlear implantation, utilizing the Health Utility Index. Three scenarios were created to reflect 1) deafness without intervention, 2) unilateral CI, and 3) bilateral CI. Cost evaluation reflected the burden on a publicly funded healthcare system. The base case included 25 years of service provision, processor upgrades every 5 years, 50% price reduction for second side, and 15% failure rate. Discounting and sensitivity analyses were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Costs were $63,632 (unilateral CI), $111,764 (bilateral CI), and $48,132 (incremental cost of second CI). The health preference gained from no intervention to unilateral CI, and to bilateral CI were 0.270 and 0.305. Incremental utility gained by the second implant was 11.5% of total. The incremental cost\u2010utility ratio (ICUR) was $14,658\/quality\u2010adjusted life year (QALY) for bilateral CI compared to no intervention. It was stable regardless of discounting or sensitivity analyses. ICUR was $55,020\/QALY from unilateral to bilateral CI with higher uncertainties. It improved with differential discounting, further second\u2010side price reduction, and reduced frequency of processor upgrades. ICUR worsened with reduced length of use and higher failure rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sequential bilateral CI was cost\u2010effective when compared to no intervention, although gains were made mostly by the first implant. Cost\u2010effectiveness compared to unilateral implantation was borderline but improved through base case variations to reflect long\u2010term gains or cost\u2010saving measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      2C\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 124:1452\u20131458, 2014\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.24537","type":"journal-article","created":{"date-parts":[[2013,11,27]],"date-time":"2013-11-27T01:54:58Z","timestamp":1385517298000},"page":"1452-1458","source":"Crossref","is-referenced-by-count":49,"title":["Cost\u2010utility analysis of bilateral cochlear implantation in adults: A health economic assessment from the perspective of a publicly funded program"],"prefix":"10.1002","volume":"124","author":[{"given":"Joseph M.","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Toronto, Sunnybrook Health Sciences Centre Toronto, Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossam","family":"Amoodi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Toronto, Sunnybrook Health Sciences Centre Toronto, Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Mittmann","sequence":"additional","affiliation":[{"name":"The HOPE Research Centre (Health Outcomes &amp; Pharmaco\u2010economics) Sunnybrook Health Sciences Centre Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,1,15]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"72","article-title":"Technology and costs: complex relationship","volume":"62","author":"Samuel F","year":"1988","journal-title":"Hospitals"},{"key":"e_1_2_7_3_1","volume-title":"Methods for Economic Health Evaluation of Health Care Programmes","year":"2005"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AUD.0000134550.80305.04"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.125.11.1221"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-009-0151-8"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22387"},{"key":"e_1_2_7_8_1","volume-title":"Cochlear implantation for children and adults for severe to profound deafness. 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