The UK has an ageing population. Seven percent of the over 80s population have bilateral severe to profound hearing loss which can lead to associated negative outcomes (social isolation, depression and reduced quality of life). Cochlear implantation (CI) can successfully restore speech recognition for individuals with severe to profound sensorineural hearing loss for whom hearing rehabilitation using acoustic hearing aids has proved inadequate. This study investigates survival duration of CI recipients aged 80 years and over and discusses the cost utility of CI in this age group. A retrospective study was undertaken in a single centre (Cambridge University Hospitals) from 2001 to 2019. Data were collected from 122 patients. This number was reduced to 87 cases for statistical analysis for varying reasons (mostly due to lack of documented post-implant speech score data). The mean age at implantation was 84 years. The mean audiometric score improved from 108 dB HL to 28 dB HL post-implantation. The mean Bamford-Kowal-Bench (BKB) score improved from 14% to 66% and 73% at two- and 12-months post-implantation, respectively. The complication rate was 15.3%. No major cardiac, pulmonary, or neurologic anaesthetic complications were reported. The survival probability at one-year post-implantation was 0.95 for females and 0.93 for males, at three years was 0.89 for females and 0.81 for males, and at five years was 0.74 for females and 0.54 for males. Discussion centres on national guidance framework. NICE makes decisions regarding the cost-effectiveness of treatments offered by the NHS. In general interventions with an incremental cost-effectiveness ratio of less than £20,000 per quality-adjusted life year (QALY) gained are considered to be cost-effective. The authors calculate £51,667 per QALY for an 80-year-old, therefore exceeding this threshold. However, this can be argued as discriminatory and does not consider other factors (prevention of dementia). This study arguably shows the benefit in implanting suitable patients over 80. With adequate rehabilitation, good audiological outcomes can be found.
Cochlear implants in the over 80s
Reviewed by Aaron Ferguson
Cochlear Implantation in Elderly Patients: Survival Duration, Hearing Outcomes, Complication Rates, and Cost Utility.
