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Robotic Cochlear Implantation for Direct Cochlear Access
Published on: June 16, 2022
Cost-utility analysis of the cochlear implant in children
A K Cheng1, H R Rubin, N R Powe
1Department of Otolaryngology, Division of Otology Neurotology, Johns Hopkins University, 601 N. Carolina St, Baltimore, MD 21287-0910, USA.
Insights
Cochlear implants significantly improve quality of life for profoundly deaf children. This study found cochlear implants offer a net societal savings, making them a cost-effective intervention.
Area of Science:
- Otolaryngology
- Pediatric Health
- Health Economics
Background:
- Barriers to pediatric cochlear implant use include cost and limited comparative data.
- Assessing the benefit of cochlear implants in children is challenging.
Purpose of the Study:
- To evaluate the impact of cochlear implants on quality of life for children with profound deafness.
- To analyze the cost-effectiveness and societal economic consequences of pediatric cochlear implantation.
Main Methods:
- A cost-utility analysis was performed using pre- and post-intervention surveys.
- Data were collected from 78 profoundly deaf children and their parents at a US academic medical center.
- Quality-adjusted life-year (QALY) was calculated using TTO, VAS, and HUI measures, with 3% annual discounting.
Main Results:
- Cochlear implant use led to significant improvements in quality-of-life scores across TTO, VAS, and HUI measures.
- Direct costs per QALY ranged from $5,197 to $9,029, depending on the utility measure used.
- When indirect costs were included, cochlear implants resulted in a net societal savings of $53,198 per child.
Conclusions:
- Pediatric cochlear implantation positively impacts quality of life.
- Cochlear implants represent a cost-effective intervention for profound deafness in children.
- The use of cochlear implants in children leads to overall societal cost savings.
Context:
Barriers to the use of cochlear implants in children with profound deafness include device costs, difficulty assessing benefit, and lack of data to compare the implant with other medical interventions.
Objective:
To determine the quality of life and cost consequences for deaf children who receive a cochlear implant.
Design:
Cost-utility analysis using preintervention, postintervention, and cross-sectional surveys conducted from July 1998 to May 2000.
Setting:
Hearing clinic at a US academic medical center.
Participants:
Parents of 78 profoundly deaf children (average age, 7.5 years) who received cochlear implants.
Main Outcome Measures:
Direct and total cost to society per quality-adjusted life-year (QALY) using the time-trade-off (TTO), visual analog scale (VAS), and Health Utilities Index-Mark III (HUI), discounting costs and benefits 3% annually. Parents rated their child's health state at the time of the survey and immediately before and 1 year before implantation.
Results:
Recipients had an average of 1.9 years of implant use. Mean VAS scores increased by 0. 27, from 0.59 before implantation to 0.86 at survey. In a subset of participants, TTO scores increased by 0.22, from 0.75 to 0.97 (n = 40) and HUI scores increased by 0.39, from 0.25 to 0.64 (n = 22). Quality-of-life scores were no different 1 year before and immediately before implantation. Discounted direct costs were $60,228, yielding $9,029 per QALY using the TTO, $7,500 per QALY using the VAS, and $5,197 per QALY using the HUI. Including indirect costs such as reduced educational expenses, the cochlear implant provided a savings of $53,198 per child.
Conclusions:
Cochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society. JAMA. 2000;284:850-856
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