Aims: Simultaneous bilateral cochlear implantation (SiBiCI) offers significant advantages over sequential bilateral CI (SeqBiCI). The aim of this study is (1) to outline the clinical and cost advantages of SiBiCIs for children with severe to profound bilateral hearing loss in the Victorian public health service and (2) highlight the current funding challenges for Australian hospitals in utilising this intervention. Methodology: A systematic literature review examined clinical outcomes and costs associated with paediatric SiBiCI, including speech and language development, social skills, safety, direct and indirect healthcare costs. A cost analysis of SiBiCIs vs SeqBiCIs was developed from a Victorian state perspective, including Australian Refined Diagnosis Related Group (AR-DRG) in-patient funding, post-implant care and implementation of the Australian National Weighted Activity Unit (NWAU) framework in 2020-21. Results: The systematic review demonstrated SiBiCI provides: 1.Improved speech and language development. 2.Improved adaptability and social skills. 3.Equivalent safety. No significant difference in peri-operative and post-operative complications, and reduced total (cumulative) surgical time and total length of hospital stay. 4.Lower total direct healthcare costs. Total hospital stay and post-implant care 5.Lower indirect costs. Travel costs and parents time away from work. The costing analysis of SiBiCIs vs SeqBiCIs from a Victorian perspective confirmed the systematic review with regard to total hospital stay and post-implant care, but highlighted funding challenges resulting from the NWAU framework, as unilateral and SiBiCi receive the same AR-DRG payment. Conclusion: SiBiCIs provide clinical benefits and cost savings for paediatric patients with severe to profound bilateral hearing loss. However, with the current funding model, hospitals with paediatric CI programs face a recurring funding burden.