CI Atlas · Was It Worth It? Measuring Quality of Life and the Cost of an Implant · Module 03

3The Generic Yardsticks: HUI3, EQ-5D and Utility

Generic preference-based instruments turn a described health state into a single utility, anchored at 0 (death) and 1.0 (perfect health), so a cochlear implant can be compared against any other treatment. This module unpacks HUI3, EQ-5D and SF-6D, how each maps a state to a utility, why HUI3 is the CI workhorse because it contains a hearing attribute, and why generic measures are insensitive to hearing.

FUtility and the QALY

A health utility is anchored at 0 (death) and 1.0 (perfect health), letting states be ranked and given a cardinal value so interventions for different diseases compare on one yardstick. A QALY is years of life multiplied by the utility weight; 20 years at 0.2 yields 4 QALYs, and cost-utility analysis reports cost per QALY gained. Profound adult deafness carries a mean utility decrement of about -0.46, the loss a cochlear implant partially reverses.[1986][1989][2009]

TWhere utilities come from

Utilities are elicited directly by VAS, time trade-off (TTO) and standard gamble (SG), or read from multi-attribute instruments (HUI, EQ-5D) using population-survey weights. Across methods CI gains are real: Summerfield's VAS work showed +0.41 and +0.23, and Palmer found +0.20 over one year in 46 implanted versus 16 controls.[1989][1995][1999]

THUI3, EQ-5D and SF-6D, and the blind spot

HUI3 scores eight attributes including hearing and speech, so it is favoured for otology; EQ-5D (5 dimensions) and SF-6D (6 dimensions) contain no hearing dimension. Adults gain about +0.19 to +0.26 in HUI3 utility (pooled +0.26), underpinning a cost-utility near $12,847 per QALY (range $9,000-$31,177), within $20,000-$50,000 thresholds. Generic measures improve mainly in non-hearing domains and so underestimate hearing benefit, which is why hearing-specific tools like NCIQ and CIQOL were developed.[1996][2001][1996][2019]

Case 20.3 · The Generic Yardsticks

A commissioner asks your CI programme to justify funding. Forty adult postlingual recipients show only a small, non-significant EQ-5D change, yet describe dramatically better telephone use and confidence, and their NCIQ scores rose sharply. The commissioner questions cost-effectiveness given the flat EQ-5D.

How should you interpret the flat EQ-5D against the clear NCIQ and patient-reported gains?

Self-assessment — Module 32 questions

Question 1

Which instrument is preferred for CI cost-utility analysis because it explicitly contains a hearing attribute?

Question 2

Pooled across seven studies adults gain about +0.26 in HUI3 utility after CI, supporting a weighted-average cost-utility near which value?

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