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

Abstract

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.

Bone-anchored hearing aids (BAHAs) for people who are bilaterally deaf: a systematic review and economic evaluation

“…For example, the HUI2 contains a single 'sensation' attribute relating to sight, hearing and speech, whereas the HUI3 contains separate attributes for each of these senses. As a result of the inclusion of separate attributes for the sensations and demonstrated improved sensitivity over other generic QoL measures, 112 the HUI3 has been used in previous economic evaluations of hearing aid devices [117][118][119] and for descriptive studies of QoL before and after hearing aid provision. 113 As was noted in our review of QoL studies, the HUI appears to be a more suitable generic measure for QoL in a population with hearing difficulties than the EQ-5D or SF-36.…”

Rates of Long‐term Cochlear Implant Use in Children

“…[19][20][21] Our results appear to bolster and can further refine models of cost-utility indicating that earlier cochlear implantation of childhood candidates provides significantly greater utility. 22 Indeed, device non-use observed in the present study would substantially reduce predicted cost-utility in children who received their implants at older ages.…”

Recent advances in hearing restoration

“…2 Given that the cost of gaining a QALY is lowest for those treated both at a younger age and sooner following deafness, the overall financial benefits of restorative treatments are significant for healthcare services and employers alike. 1,33 For example, the lifetime costs per QALY reveal that CIs are a cost-effective intervention in the majority of patients, irrespective of age (average cost per QALY is £27,142). 30 The figures are even more impressive when implantation is limited to those patients with profound deafness that fulfil more stringent selection criteria for benefit.…”

“…As delays in treatment worsen the degeneration of the disused auditory pathways, early intervention has been proven to provide maximal cost-effectiveness and quality of life improvement. 1 Early correction is particularly important for the 12,000 UK children born prelingually deaf, in whom the lack of early auditory input can restrict language development, a prerequisite for social interaction. 2,28 Likewise, long delays prior to implantation are associated with poor hearing outcomes amongst individuals who have experienced normal hearing before the onset of deafness.…”

“…In the UK there are approximately nine million people with hearing impairments, and a further 28 million in the USA 1,2,3 More than half of these individuals are over the age of sixty-five. 4 With the world's population ageing, the already substantial but somewhat hidden social and financial burdens of hearing loss seem likely to increase.…”