Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3

Abstract

Objectives/hypothesis: To evaluate the changes in health-related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short-Form Survey-36 (SF-36) and the Health Utility Index Mark 3 (HUI-3). To do so, a health utility index was obtained by converting the SF-36 to the Medical Outcome Study Short-Form Survey-6D (SF-6D) to permit comparison with HUI-3 scores in the context of health preference as measured by quality-adjusted life years.

Study design: Prospective cohort study.

Methods: Eighty-one postlingually deaf adult patients undergoing cochlear implantation completed the SF-36 and HUI-3 preoperatively and at a median of 1.4 years (range, 11 months-5 years) after cochlear implantation.

Results: The SF-36 improvement was statistically significant in two domains. The SF-36 data were converted to SF-6D. Preoperatively, the mean SF-6D utility score was 0.575 ± 0.056. One year postoperatively this score increased to 0.590 ± 0.064. The improvement of 0.015 ± 0.082 was not statistically significant (P = .1118). Of the HUI-3 attributes, two showed improvement between preoperative and postoperative evaluations. The overall HUI-3 score increased from 0.464 ± 0.207 preoperatively to 0.611 ± 0.190 postoperatively. The gain of 0.146 ± 0.19 was statistically significant (P < .0001). The intraclass correlation coefficient between the SF-6D and HUI-3 showed a very small correlation, both pre- and postoperatively.

Conclusions: Against the backdrop of diminishing resources for healthcare, cost-effective analysis is fast becoming an important tool. There remains a strong need for health-related quality-of-life instruments that can truly reflect the benefit of cochlear implantation, in which utility estimates are fundamentally important. The SF-36 scores, when converted to SF-6D, do not correlate well with HUI-3 scores in a cohort of adult cochlear implant recipients. The HUI-3 remains the most appropriate tool for this patient group.

Level of evidence: 4

Keywords: Hearing; cochlear implant; cost benefit; quality of life; questionnaire.