A Cost-Utility Scenario Analysis of Bilateral Cochlear Implantation

Summerfield, A. Quentin; Marshall, David; Barton, Garry; Bloor, Karen

doi:10.1001/archotol.128.11.1255

Cited by 97 publications

(144 citation statements)

References 19 publications

(25 reference statements)

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“…One active area of research is to demonstrate the effectiveness of bilateral cochlear implants and justify the cost of the second implant [209]. The current bilateral implants are essentially two independent devices, showing mostly the better ear or the head shadow effect [210].…”

Section: Beyond Cochlear Implantsmentioning

confidence: 99%

Cochlear Implants: System Design, Integration, and Evaluation

Zeng

Rebscher

Harrison³

et al. 2008

IEEE Rev. Biomed. Eng.

656

198

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As the most successful neural prosthesis, cochlear implants have provided partial hearing to more than 120,000 persons worldwide; half of which being pediatric users who are able to develop nearly normal language. Biomedical engineers have played a central role in the design, integration and evaluation of the cochlear implant system, but the overall success is a result of collaborative work with physiologists, psychologists, physicians, educators, and entrepreneurs. This review presents broad yet in-depth academic and industrial perspectives on the underlying research and ongoing development of cochlear implants. The introduction accounts for major events and advances in cochlear implants, including dynamic interplays among engineers, scientists, physicians, and policy makers. The review takes a system approach to address critical issues from design and specifications to integration and evaluation. First, the cochlear implant system design and specifications are laid out. Second, the design goals, principles, and methods of the subsystem components are identified from the external speech processor and radio frequency transmission link to the internal receiver, stimulator and electrode arrays. Third, system integration and functional evaluation are presented with respect to safety, reliability, and challenges facing the present and future cochlear implant designers and users. Finally, issues beyond cochlear implants are discussed to address treatment options for the entire spectrum of hearing impairment as well as to use the cochlear implant as a model to design and evaluate other similar neural prostheses such as vestibular and retinal implants.

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Section: Beyond Cochlear Implantsmentioning

confidence: 99%

Cochlear Implants: System Design, Integration, and Evaluation

Zeng

Rebscher

Harrison³

et al. 2008

IEEE Rev. Biomed. Eng.

656

198

View full text Add to dashboard Cite

show abstract

“…The incremental health sector costs of implantation were estimated by deducting the cost of alternative treatments (as estimated by Summerfield, Marshall, Barton, & Bloor, 2002) from the health sector costs of pediatric cochlear implantation (as estimated by Barton et al, 2003). The incremental costs of implantation incurred in the health sector, in the education sector (Barton et al, 2006a), and by the families of implanted children (Barton et al, 2006b) were summed to estimate the incremental societal cost of implantation.…”

Section: Accumulating Utility and Costsmentioning

confidence: 99%

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

et al. 2006

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Objective: To estimate the cost-effectiveness of pediatric cochlear implantation by conducting a costutility analysis from a societal perspective. Design:In a cross-sectional survey, the parents of a representative sample of hearing-impaired children assessed the health utility of their child using a revised version of the Health Utilities Index Mark III questionnaire. Linear regression was used to estimate the gain in health utility associated with implantation while controlling for eight potentially confounding variables: average (4-frequency, unaided, preoperative) hearing level (AHL), age at onset of hearing-impairment, age, gender, number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The gain in health utility was accumulated to estimate the number of quality-adjusted life years (QALYs) that would be gained from implantation over 15 yr and over a child's lifetime. The incremental societal cost of implantation, calculated in euros (€) at 2001/2 levels, was estimated by summing the incremental costs of implantation that are incurred in the health sector, in the education sector, and by the child's family. The cost-effectiveness of cochlear implantation was estimated by calculating the incremental societal cost per QALY gained and was compared with an upper limit of acceptability of €50,000 per QALY. Results:The parents of 403 implanted children, and 1863 nonimplanted children, completed the health utility questionnaire. Higher health utility was associated with a more favorable AHL, an older age at onset of hearing impairment, female gender, having fewer additional disabilities, having parents with a greater occupational skill level, white ethnicity, and implantation. The gain in health utility associated with implantation was estimated to be higher for children with a worse preoperative AHL and who were implanted when younger. Over 15 yr, for a child implanted at age 6 with a preoperative loss of 115 dB, 2.23 QALYs were estimated to be gained, compared with a mean incremental societal cost of €57,359, yielding a mean cost per QALY of €25,629.Cost-effectiveness was more favorable: (1) when estimated over a child's lifetime rather than 15 yr, (2) for children with a worse preoperative AHL, and (3) for children who were implanted when younger. Conclusions:The mean cost of gaining a QALY for the children in the present sample falls within acceptable limits. The strategy of giving highest priority for implantation to children with the greatest loss of hearing, and who are younger, maximizes benefit for a given cost.

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“…Although the vast majority of CI users can understand speech in a quiet situation (Zeng, 2004;Stickney et al, 2004;Holt & Kirk, 2005), and report improvement in quality of life postimplantation (Summerfield et al, 2002), they have continued difficulties under many circumstances. For instance, most CI users have difficulty locating sounds in their environments; all sounds appear to be coming either directly from their ear, or inside their head.…”

Section: Introductionmentioning

confidence: 99%

Benefits of bilateral cochlear implants and/or hearing aids in children

Litovsky

Johnstone

Godar

2006

International Journal of Audiology

234

198

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This study evaluated functional benefits from bilateral stimulation in 20 children ages 4 -14, 10 use two CIs and 10 use one CI and one HA. Localization acuity was measured with the minimum audible angle (MAA). Speech intelligibility was measured in quiet, and in the presence of 2-talker competing speech using the CRISP forced-choice test. Results show that both groups perform similarly when speech reception thresholds are evaluated. However, there appears to be benefit (improved MAA and speech thresholds) from wearing two devices compared with a single device that is significantly greater in the group with two CI than in the bimodal group. Individual variability also suggests that some children perform similarly to normal-hearing children, while others clearly do not. Future advances in binaural fitting strategies and improved speech processing schemes that maximize binaural sensitivity will no doubt contribute to increasing the binaurally-driven advantages in persons with bilateral CIs. KeywordsBilateral; Binaural; Cochlear implant; Hearing aid; Children; Speech; Localization Cochlear implants (CIs) have become a powerful means of providing hearing to deaf persons. Although the vast majority of CI users can understand speech in a quiet situation (Zeng, 2004;Stickney et al, 2004;Holt & Kirk, 2005), and report improvement in quality of life postimplantation (Summerfield et al, 2002), they have continued difficulties under many circumstances. For instance, most CI users have difficulty locating sounds in their environments; all sounds appear to be coming either directly from their ear, or inside their head. In addition, their ability to understand speech in everyday, noisy and reverberant environments is quite poor (e.g., Fu et al, 1998;Nelson & Jin, 2004;Stickney et al, 2004Stickney et al, , 2005. Continuous efforts are being made to improve performance with single CIs by developing better speech processing strategies (e.g., Rubinstein & Hong, 2003;Green et al, 2005;Nie et al, 2005;Yang & Fu, 2005).Bilateral CIs (BI-CIs) are also being provided to a growing number of patients in an attempt to increase quality of life and to improve listening in everyday noisy situations. This clinical approach is primarily rooted in the assumption that, since normal-hearing people rely on two ears (binaural hearing) for sound localization and speech understanding in noise, deaf individuals should also have two good ears in order to maximize their performance. Bilaterally implanted adults show some clear and significant benefits when using two CIs compared with a single CI. As in normal hearing persons, speech understanding in noise is better in bilateral NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript users when both ears are activated compared with a monaural condition (Gantz et al, 2002;Tyler et al, 2002;Muller et al, 2002;Litovsky et al, 2004;Schleich et al, 2004). The benefits are thought to arise from a combination of effects, including the head shadow effect, binaural squelch and binaural...

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A Cost-Utility Scenario Analysis of Bilateral Cochlear Implantation

Abstract: More quality of life is likely to be gained per unit of expenditure on unilateral implantation than bilateral implantation.

Cited by 97 publications

References 19 publications

Cochlear Implants: System Design, Integration, and Evaluation

Cochlear Implants: System Design, Integration, and Evaluation

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

Benefits of bilateral cochlear implants and/or hearing aids in children

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