Purpose <p>This study estimates the cost-effectiveness of unilateral cochlear implants (UCIs) for Finnish adults with severe to profound hearing loss within the contemporary Finnish healthcare system.</p> Methods <p>We conducted a cost-utility analysis using a Markov model to compare UCIs with hearing aids for adults with severe to profound hearing loss. We developed an average clinical pathway based on data from three Finnish university hospitals to estimate resource use. The model captured health-related quality of life, potential adverse events, device upgrades, and device failure. We estimated unit costs from national expert opinions and from grey and published literature. We performed a probabilistic sensitivity analysis to evaluate how uncertain model inputs affect the incremental cost-effectiveness ratio (ICER).</p> Results <p>The ICER for UCIs compared to hearing aids in the Finnish adult population was €14,528 per quality-adjusted life year (QALY). The cost-effectiveness acceptability curve indicated a 98,5% likelihood that UCIs are cost-effective compared to a €25,000 per QALY gained threshold. The ICER was most sensitive to the discount rate, UCI device and surgery costs, the utility increment from UCI treatment, costs associated with UCI fitting, and the cost and upgrade cycle of sound processors.</p> Conclusion <p>UCIs for adults are cost-effective within the Finnish healthcare setting. Our results align with ICER findings for UCIs in the UK and Swedish adult populations, despite differences in indications, clinical pathways, and device unit costs. All studies suggest that UCIs are more cost-effective when implemented at an earlier age, given the same level of hearing performance.</p>