Oct 2019 The Hearing Journal

(Editors note - interested readers can refer to the full, lengthy, article where the economic aspects relate mainly to the USA while the non-economic factors probably apply worldwide) 

Cochlear implants (CIs) are cost-effective devices that improve the speech understanding and quality of life (QofL) of people with severe-to-profound hearing loss (SPHL). Over time, the CI candidacy criteria have expanded to include individuals with substantial residual hearing. But even within the SPHL population, CI utilisation remains low (5-10%) for reasons that are not fully understood. Proposed explanations include limited access to CI centres, lack of standardised candidacy determination, and provider discomfort with or lack of awareness of the expanding candidacy criteria.

CI utilisation is influenced by several economic issues, particularly cost effectiveness—an important determinant of an insurer's willingness to cover CI services. However, cost-effectiveness evidence only plays an indirect role in determining who receives CI. The decision of whether to utilise CI results from a shared decision-making process involving patients and their providers. We will consider the gaps that exist in CI cost-effectiveness evidence and other economic factors that affect patient and provider decisions related to CI use.

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