Cochlear implantation as a treatment for single-sided deafness and asymmetric hearing loss: a randomized controlled evaluation of cost-utility

Mathieu Marx, Nadège Costa, Benoit Lepage, Soumia Taoui, Laurent Molinier, Olivier Deguine, Bernard Fraysse, Mathieu Marx, Nadège Costa, Benoit Lepage, Soumia Taoui, Laurent Molinier, Olivier Deguine, Bernard Fraysse

Abstract

Background: Single-sided deafness (SSD) and asymmetric hearing loss (AHL) have recently been proposed as a new indication for cochlear implantation. There is still no recommended treatment for these hearing deficits, and most options considered rely on the transfer of sound from the poor ear to the better ear, using Contralateral Routing of the Signal (CROS) hearing aids or bone conduction (BC) devices. In contrast, cochlear implantation allows the poor ear to be stimulated and binaural hearing abilities to be partially restored. Indeed, most recently published studies have reported an improvement in the spatial localisation of an incoming sound and better speech recognition in noisy environments after cochlear implantation in SSD/AHL subjects. It also provides consistent relief of tinnitus when associated. These encouraging hearing outcomes raise the question of the cost-utility of this expensive treatment in an extended indication.

Methods: The final endpoint of this national multicentre study is to determine the incremental cost-utility ratio (ICUR) of cochlear implantation in comparison to the current standard of care in France through simple observation, using a randomised controlled trial. Firstly, the study comprises a prospective and descriptive part, where 150 SSD/AHL subjects try CROS hearing aids and a BC device for three weeks each. Secondly, the choice is made between CROS hearing aids, BC implanted device and cochlear implantation. Hearing outcomes and quality of life measurements are described after 6 months for the subjects who chose CROS, BC or declined any option. The subjects who opt for cochlear implantation are randomised between one group where the cochlear implant is inserted without delay and one group of simple initial observation. Hearing outcomes and quality of life measurements are compared after 6 months.

Discussion: The present study was designed to assess the efficiency of cochlear implantation in SSD/AHL. A favourable cost-utility ratio in this extended indication would strengthen the promising clinical results and justify a reimbursement by the health insurance. The efficiency of other options (CROS, BC) will also be described.

Trial registration: This research has been registered in ClinicalTrials.gov (http://www.clinicaltrials.gov/), the 29th July 2014 under the n°NCT02204618.

Keywords: Asymmetric hearing loss; Binaural hearing; Cochlear implant; Cost-utility; Single-sided deafness; Tinnitus.

Conflict of interest statement

All of the authorisations required in accordance with French legislation were obtained for this study: “Agence Nationale de Sécurité du Médicament” (ANSM, National Agency of Drug Safety) (authorisation dated May 2014), and approved by the “Commission Nationale Informatique et Libertés” (CNIL, French National Agency regulating Data Protection). This study was presented to the South-West and Overseas territories’ Ethics Committee on May 2014. All of the patients taking part in this clinical trial have received verbal and written information and have been able to ask questions about the study. They willingly signed an informed consent form before starting the trial.Not applicable. No private information of patients will be published.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trial design:the choice of the treatment option is made after a consecutive trial of CROS hearing aids and BAHA on a headband; subjects who opt for a cochlear implant are randomized between initial observation and cochlear implantation

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