Evaluating the Clinical- and Cost-Effectiveness of Cochlear Implant Sound Processor Upgrades in Older Adults: Outcomes from a Large Australian Multicenter Study

Incerti, PV; Pang, J; Gavrilis, J; Zhang, VW; Tsiolkas, J; Sharma, R; Seil, E; Ahumada-Canale, A; Parkinson, B; Kitterick, PT

Evaluating the Clinical- and Cost-Effectiveness of Cochlear Implant Sound Processor Upgrades in Older Adults: Outcomes from a Large Australian Multicenter Study

Incerti, PV Pang, J Gavrilis, J Zhang, VW Tsiolkas, J Sharma, R Seil, E Ahumada-Canale, A Parkinson, B Kitterick, PT

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Publisher:: MDPI
Publication Type:: Journal Article
Citation:: Journal of Clinical Medicine, 14, (11), pp. 3765

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Field	Value	Language
dc.contributor.author	Incerti, PV
dc.contributor.author	Pang, J
dc.contributor.author	Gavrilis, J
dc.contributor.author	Zhang, VW
dc.contributor.author	Tsiolkas, J
dc.contributor.author	Sharma, R
dc.contributor.author	Seil, E
dc.contributor.author	Ahumada-Canale, A
dc.contributor.author	Parkinson, B
dc.contributor.author	Kitterick, PT
dc.date.accessioned	2025-06-02T23:43:10Z
dc.date.available	2025-06-02T23:43:10Z
dc.identifier.citation	Journal of Clinical Medicine, 14, (11), pp. 3765
dc.identifier.issn	2077-0383
dc.identifier.issn	2077-0383
dc.identifier.uri	http://hdl.handle.net/10453/187594
dc.description.abstract	Background: Many older Australian adults with cochlear implants (CI) lack funding for replacement sound processors, risking complete device failure and reduced quality of life. The need for replacement CI devices for individuals with obsolete sound processors and no access to funding poses an increasing public health challenge in Australia and worldwide. We aimed to investigate the clinical and cost-effectiveness of upgrading obsolete CI sound processors in older adults. Methods: Alongside an Australian Government-funded upgrade program, a prospective, mixed-methodology design study was undertaken. Participants were aged 65 and over, with obsolete Cochlear™ sound processors and no funding for replacements. This study compared speech perception in noise, as well as self-reported outcome measures, including cognition, listening effort, fatigue, device benefit, mental well-being, participation, empowerment and user experiences, between upgraded and obsolete hearing aid processors. The economic impact of the upgrade was evaluated using two state-transition microsimulation models of adults using CIs. Results: The multi-site study ran from 20 May 2021 to 21 April 2023, with recruitment from June 2021 to May 2022. A total of 340 Cochlear™ sound processors were upgraded in 304 adults. The adults’ mean age was 77.4 years (SD 6.6), and 48.5% were female. Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech understanding in noise and reduced communication difficulties, self-reported listening effort and fatigue. Semi-structured interviews have revealed that upgrades alleviated the anxiety and fear of sudden processor failure. Health economic analysis found that the cost-effectiveness of upgrades stemmed from preventing device failures, rather than from access to newer technology features. Conclusions: Our study identified significant clinical and self-reported benefits from upgrading Cochlear™ sound processors. Economic value came from avoiding scenarios where a total failure of device renders its user unable to access sound. The evidence gathered can be used to inform policy on CI processor upgrades for older adults.
dc.language	en
dc.publisher	MDPI
dc.relation.ispartof	Journal of Clinical Medicine
dc.relation.isbasedon	10.3390/jcm14113765
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences
dc.subject.classification	32 Biomedical and clinical sciences
dc.title	Evaluating the Clinical- and Cost-Effectiveness of Cochlear Implant Sound Processor Upgrades in Older Adults: Outcomes from a Large Australian Multicenter Study
dc.type	Journal Article
utslib.citation.volume	14
utslib.for	1103 Clinical Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Economics Research and Evaluation (CHERE)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2025-06-02T23:43:05Z
pubs.issue	11
pubs.publication-status	Published online
pubs.volume	14
utslib.citation.issue	11

Abstract:

Background: Many older Australian adults with cochlear implants (CI) lack funding for replacement sound processors, risking complete device failure and reduced quality of life. The need for replacement CI devices for individuals with obsolete sound processors and no access to funding poses an increasing public health challenge in Australia and worldwide. We aimed to investigate the clinical and cost-effectiveness of upgrading obsolete CI sound processors in older adults. Methods: Alongside an Australian Government-funded upgrade program, a prospective, mixed-methodology design study was undertaken. Participants were aged 65 and over, with obsolete Cochlear™ sound processors and no funding for replacements. This study compared speech perception in noise, as well as self-reported outcome measures, including cognition, listening effort, fatigue, device benefit, mental well-being, participation, empowerment and user experiences, between upgraded and obsolete hearing aid processors. The economic impact of the upgrade was evaluated using two state-transition microsimulation models of adults using CIs. Results: The multi-site study ran from 20 May 2021 to 21 April 2023, with recruitment from June 2021 to May 2022. A total of 340 Cochlear™ sound processors were upgraded in 304 adults. The adults’ mean age was 77.4 years (SD 6.6), and 48.5% were female. Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech understanding in noise and reduced communication difficulties, self-reported listening effort and fatigue. Semi-structured interviews have revealed that upgrades alleviated the anxiety and fear of sudden processor failure. Health economic analysis found that the cost-effectiveness of upgrades stemmed from preventing device failures, rather than from access to newer technology features. Conclusions: Our study identified significant clinical and self-reported benefits from upgrading Cochlear™ sound processors. Economic value came from avoiding scenarios where a total failure of device renders its user unable to access sound. The evidence gathered can be used to inform policy on CI processor upgrades for older adults.

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http://hdl.handle.net/10453/187594