We have included the cost of fixing the processor 2 into the maintenance costs (because it was included in the survey). We have not included the yearly tuning costs because we assume they are covered by the manufacturer. ]]>

Source: INE at January 2015 http://www.ine.es/jaxiT3/Tabla.htm?t=9663

]]>

Mortality rate by sex and age. Source: National Institue of Statistics (INE, Spain).

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Age of the patient

]]> 1.0 1.0

There are 3 possible decisions:

- Bilateral Cochlear Implant simultaneous

- Bilateral Cochlear Implant sequential

- No intervention

No intervention implies that the pacient only will have a UCI

]]>

Death because of surgery associated to anesthesia. In children Gonzalez et al. [2012]. In adults Braz et al. [2009]

]]>

Surgery motivated by a major complication or an internal-device failure of the second implant.

]]>

See comment for Major complic 1.

]]> 0.01

Permanent explantation of the second cochlear implant. Wang et al. [2014]

]]>

Failure of the internal device of the second implant requiring revision surgery.

]]>

Age of the second internal device in the current slice

]]>

Cost of replacing the internal components of the second implant. It is covered by the health system if it occurs after the 10-year guarantee period.

]]> 0.01

Quality of Life of the pacient

]]> 0.01

Costs of repairing the sound processor and replacing microphones, coils, cables and batteries. In Spain these costs are paid by users and their families. Source: survey

]]> 0.01

Cost of buying the cochlear implant(s).

]]> 0.01

Surgery incremental costs

Sources:

De La Torre et al. 2005

Herranz Amo et al. 2006

Feliú Pala et. 2003

Smulders et al. 2016

]]> 0.01

Source:

]]> 0.01 0.01

Age of the second external device in the current slice

]]>

Failure of the external device that requires its replacement. This node does not include failures that can be repaired, because they are considered as maintenance costs.

]]>

Age of the second external device in the current slice

]]>

Cost of replacing the external processor of the second implant. In Spain it is replaced by the health system when it is 7 or more y.o. and fails.

]]> 0.01 Source: INE ]]> 0.5086 0.4914 1.0 49.14 50.86 Source: INE ]]> 0.999795244 2.04756E-4 0.999837359 1.62641E-4 0.999884515 1.15485E-4 0.999888894 1.11106E-4 0.999916325 8.3675E-5 0.9999027 9.73E-5 0.999920936 7.9064E-5 0.999895607 1.04393E-4 0.999914406 8.5594E-5 0.999924414 7.5586E-5 0.999922599 7.7401E-5 0.99988801 1.1199E-4 0.999886709 1.13291E-4 0.999937363 6.2637E-5 0.999832443 1.67557E-4 0.999826992 1.73008E-4 0.999812668 1.87332E-4 0.999733468 2.66532E-4 0.999692577 3.07423E-4 0.99967422 3.2578E-4 0.999651388 3.48612E-4 0.999621639 3.78361E-4 0.999666354 3.33646E-4 0.999690843 3.09157E-4 0.999618961 3.81039E-4 0.999589274 4.10726E-4 0.999612398 3.87602E-4 0.999599632 4.00368E-4 0.999561684 4.38316E-4 0.999520035 4.79965E-4 0.99959663 4.0337E-4 0.999513198 4.86802E-4 0.999436 5.64E-4 0.999378905 6.21095E-4 0.999405605 5.94395E-4 0.999330357 6.69643E-4 0.999360326 6.39674E-4 0.999282135 7.17865E-4 0.999123524 8.76476E-4 0.999113474 8.86526E-4 0.998899989 0.001100011 0.998667419 0.001332581 0.998596431 0.001403569 0.998375914 0.001624086 0.998055955 0.001944045 0.997893763 0.002106237 0.997618119 0.002381881 0.997357009 0.002642991 0.996933458 0.003066542 0.996673782 0.003326218 0.99623649 0.00376351 0.995679839 0.004320161 0.995632549 0.004367451 0.995087719 0.004912281 0.994488327 0.005511673 0.993851728 0.006148272 0.993469795 0.006530205 0.993059611 0.006940389 0.992361234 0.007638766 0.991320422 0.008679578 0.990949998 0.009050002 0.990464127 0.009535873 0.988937565 0.011062435 0.988058103 0.011941897 0.986655481 0.013344519 0.986711577 0.013288423 0.985559492 0.014440508 0.984503306 0.015496694 0.982597108 0.017402892 0.980311154 0.019688846 0.980537861 0.019462139 0.977799522 0.022200478 0.974328999 0.025671001 0.972088578 0.027911422 0.968056479 0.031943521 0.965985914 0.034014086 0.961903983 0.038096017 0.957750294 0.042249706 0.951246328 0.048753672 0.946149009 0.053850991 0.940812145 0.059187855 0.932006193 0.067993807 0.922861165 0.077138835 0.913096388 0.086903612 0.902645094 0.097354906 0.889192793 0.110807207 0.877760791 0.122239209 0.859513871 0.140486129 0.846221476 0.153778524 0.826403379 0.173596621 0.813384618 0.186615382 0.791878136 0.208121864 0.776149368 0.223850632 0.767422697 0.232577303 0.73524117 0.26475883 0.720743854 0.279256146 0.701857385 0.298142615 0.68650289 0.31349711 0.682208925 0.317791075 0.706988636 0.293011364 0.999760015 2.39985E-4 0.999839895 1.60105E-4 0.99991917 8.083E-5 0.999901665 9.8335E-5 0.999926941 7.3059E-5 0.999912927 8.7073E-5 0.999899284 1.00716E-4 0.999944603 5.5397E-5 0.999905084 9.4916E-5 0.999951239 4.8761E-5 0.99992736 7.264E-5 0.999917788 8.2212E-5 0.999916715 8.3285E-5 0.999904982 9.5018E-5 0.99990376 9.624E-5 0.999899119 1.00881E-4 0.999888633 1.11367E-4 0.999821833 1.78167E-4 0.999906787 9.3213E-5 0.99985323 1.4677E-4 0.999856855 1.43145E-4 0.999884957 1.15043E-4 0.999872285 1.27715E-4 0.999837053 1.62947E-4 0.999838501 1.61499E-4 0.999844009 1.55991E-4 0.999796774 2.03226E-4 0.999836015 1.63985E-4 0.999796989 2.03011E-4 0.999791119 2.08881E-4 0.999765972 2.34028E-4 0.999790826 2.09174E-4 0.999747377 2.52623E-4 0.999740589 2.59411E-4 0.999667898 3.32102E-4 0.999615321 3.84679E-4 0.999529847 4.70153E-4 0.999524117 4.75883E-4 0.999434931 5.65069E-4 0.999416245 5.83755E-4 0.999384526 6.15474E-4 0.999299088 7.00912E-4 0.999225892 7.74108E-4 0.999140317 8.59683E-4 0.999000805 9.99195E-4 0.998915726 0.001084274 0.998703914 0.001296086 0.998581664 0.001418336 0.99847288 0.00152712 0.998215189 0.001784811 0.998194721 0.001805279 0.998035597 0.001964403 0.997666112 0.002333888 0.997689068 0.002310932 0.997480541 0.002519459 0.997321294 0.002678706 0.99710757 0.00289243 0.996922797 0.003077203 0.99666615 0.00333385 0.996390545 0.003609455 0.996247341 0.003752659 0.995839689 0.004160311 0.995781283 0.004218717 0.9955049 0.0044951 0.995029147 0.004970853 0.994828946 0.005171054 0.993889926 0.006110074 0.993696351 0.006303649 0.992220979 0.007779021 0.991734139 0.008265861 0.991371089 0.008628911 0.990386301 0.009613699 0.988377103 0.011622897 0.986848956 0.013151044 0.984999731 0.015000269 0.982932844 0.017067156 0.980690187 0.019309813 0.97779257 0.02220743 0.974025373 0.025974627 0.969584693 0.030415307 0.964592347 0.035407653 0.958369785 0.041630215 0.952323082 0.047676918 0.944467655 0.055532345 0.936198751 0.063801249 0.923106811 0.076893189 0.914781305 0.085218695 0.897644931 0.102355069 0.886799003 0.113200997 0.868390509 0.131609491 0.849633237 0.150366763 0.832467422 0.167532578 0.810819125 0.189180875 0.796183104 0.203816896 0.765093888 0.234906112 0.74646562 0.25353438 0.732384116 0.267615884 0.713914212 0.286085788 0.69666429 0.30333571 0.681281846 0.318718154 1.0 yes no no yes no We have estimated that in developed countries the perioperative rate is less than 1/10,000 for children (Gonzalez et al. 2012, Anesthesia-related mortality in pediatric patients: A systematic review) and less than 20/10,000 in adults (Braz et al. 2009, Mortality in anesthesia: A systematic review). This seems to be an overestimation for young and middle-age adults. ]]> 0.9999 1.0E-4 1.0 0.01 99.99 0.998 0.002 1.0 0.2 99.8 no yes yes no Sources: Bond et al. (2007); Summerfield et al. (2010) ]]> 0.959 0.040999999999999995 1.0 4.1 95.9 0.996 0.004 1.0 0.4 99.6 no We assume that cost of surgery is always covered by the health system. In a previous version of the model we assumed that when the revision is due to a failure of the internal component during the guarantee period, the surgical intervention was covered by the manufacturer; but this is not usually the case in Spain. ]]> 0.0 4500.0 4500.0 900.0 both implants only first implant Source: Wang et al. (2014) ]]> Tbis probability is between 4.5 and 5% according with Wang et al. [2014]. ]]> 0.9570000000000001 0.043 1.0 4.3 95.7 no Source: Bond et al. (2007) ]]> 0.9965 0.0034999999999999996 1.0 0.35 99.65 0.9989999999999999 0.001 1.0 0.1 99.9 no 0 0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 Source: MED-EL ]]> 0.0 0.0 13000.0 13000.0 2600.0 Source: 0.106 QALYs (Artaso & Díez, 2015). ]]> 0.0 Source: Artaso & Díez (2015) ]]> 0.106 22.83271 0.00459307 Source: CIU survey conducted by CISIAD ]]> 0.0 Source: CIU survey conducted by CISIAD ]]> 674.9 155.9608 4.314402 Source: CIU survey conducted by CISIAD ]]> 1349.7999999999997 1349.8 269.96 0.0 Source: CIU survey conducted by CISIAD ]]> 372.9 37.49123 9.865894 Source: CIU survey conducted by CISIAD ]]> 745.8 745.8 149.16

Sources: GAES 19,000 €/QALY; MED-EL 23,000 €/QALY (2015)

]]> 0.0 From the manufacturers. The standard deviation might less than 20%. ]]> 21000.0 21000.0 4200.0 Cost of surgery room (including personnel and materials): 229 €, the average of 169 €/h (Herranz Amo et al., 2006) and 289 €/h (Feliu Pala et al., 2003). According to (Smulders et al., 2016), simultaneous bilateral cochlear implantation takes 100 more minutes, which leads to a cost of 382 €. The cost of sequential BCI is estimated from (de la Torre et al., 2005): 1,000 € for the pre-surgical assessment (50% of the cost of selection and exploration) plus 3,500 € for the surgical intervention. ]]> 0.0 382.0 4500.0 382.0 76.4 4500.0 900.0 From de la Torre et al. (2005). We assume that the cost of habilitation for simultaneous BCI is the same as that of UCI. ]]> 0.0 0.0 600.0 600.0 120.0 We assigned these probabilities because in the 50 cases reported by Ramsden et al. (2009) it was always possible to put both implants in one surgery, as planned, but out of the 50 cases reported by Holland et al. (2012) it was possible only in 39 patients; in 10 cases the second ear has to be implanted later, usually because of otitis media in that ear at the moment of the first surgery, and one patient received only one implant for unknown reasons. ]]> 1.0 0.0 0.0 0.01 0.89 0.1 0.0 0.0 1.0 From (Summerfield et al., 2010) ]]> 0.0 From (Summerfield et al., 2010) ]]> 0.1056 0.1056 0.1217 0 Source: Bond et al. (2007) ]]> 0.89604 0.10396 1.0 10.396 89.604 0.84 0.16 1.0 16.0 84.0 0.885 0.115 1.0 11.5 88.5 0.84 0.16 1.0 16.0 84.0 0.905 0.095 1.0 9.5 90.5 no 0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.0 Source: MED-EL ]]> 0.0 0.0 6300.0 6300.0 1260.0 COST_EFFECTIVENESS € 100 BEGINNING