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Health-service costs of pediatric cochlear implantation: multi-center analysis
Garry R Barton1, Karen E Bloor, David H Marshall
1MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, UK. grb@ihr.mrc.ac.uk
Insights
The lifetime cost of pediatric cochlear implantation (CI) in the UK is substantial, with ongoing maintenance costs rising significantly over time. These long-term expenses require careful consideration in healthcare resource allocation.
Area of Science:
- Health Economics
- Otolaryngology
- Pediatric Healthcare
Background:
- Pediatric cochlear implantation (CI) involves surgery and lifelong care, incurring significant initial and ongoing costs.
- Previous cost assessments were limited by early data, single-center perspectives, or reliance on hospital charges.
- A comprehensive, multi-center evaluation is needed to accurately determine the costs of pediatric CI in the UK.
Purpose of the Study:
- To conduct a multi-center evaluation of the health-service costs associated with unilateral cochlear implantation (CI) for children in the United Kingdom (UK).
- To estimate costs across different management phases: pre-operative assessment, implantation, tuning, and long-term maintenance.
- To project future costs based on current service delivery models.
Main Methods:
- Prospective monitoring of annual implantations across all UK pediatric CI programs since 1991.
- Resource utilization measured in 12 programs (1998/1999) and retrospectively analyzed.
- Economic micro-costing methods applied to estimate health-service costs for management phases.
- Cost robustness assessed by varying parameter values; total UK health-service costs estimated.
Main Results:
- Per-child average costs estimated at €42,972 (1-year), €73,763 (15-years), and €95,034 (73-years).
- Total UK health-service cost for unilateral pediatric CI was €14 million in 2000/2001, projected to reach €23 million by 2015/2016.
- Maintenance costs represented 22% of total costs in 2000/2001, projected to rise to 63% by 2015/2016.
Conclusions:
- Ongoing maintenance costs for pediatric cochlear implant recipients are substantial.
- These long-term expenses must be integrated into healthcare resource allocation decisions for pediatric CI services.
Objective:
Pediatric cochlear implantation (CI) entails surgery followed by lifetime maintenance, and hence incurs both initial and ongoing costs. Previous assessments of these costs were either undertaken early in the evolution of services, or were based on single hospitals, or estimated costs largely from hospital charges. The aim was to overcome these limitations by conducting a multi-center evaluation of the costs of providing unilateral CI to children in the United Kingdom (UK).
Methods:
Annual numbers of implantations in all UK pediatric CI programs were monitored prospectively from 1991. Resource use was measured in 12 programs in 1998/1999 and retrospectively back to the year of inception of each program. The profile of outpatient and outreach visits was assessed in the 12 programs. Together these variables were used to estimate health-service costs for four phases of management: pre-operative assessment, implantation, tuning, and subsequent maintenance, using economic micro-costing methods. Costs were subsequently estimated for all children implanted in 1998/1999 (N=199) and were aggregated over 1, 15, and 73 years following implantation. To assess the robustness of cost estimates, parameter values were varied over plausible ranges and costs re-estimated. Total UK health-service costs were also estimated. All costs are presented in euros (1=US dollars 0.98= pound 0.65, 1st July 2002), inflated to 2000/2001 financial-year levels, and discounted at 6% per annum.
Results:
Per-child average costs were 42972 (1-year), 73763 (15-years), and 95034 (73-years). Cost estimates were not overly sensitive to the value of any one cost component nor to the relative cost of outpatient and outreach visits. When these parameters were varied, costs ranged between 30000 and 47000 (1-year), 61000 and 83000 (15-years), and 82000 and 108000 (73-years). The total UK health-service cost of unilateral pediatric CI was estimated to be 14 million in 2000/2001 and is predicted to rise to 23 million in 2015/2016, if the present model of service-delivery continues. The cost of maintaining implanted children was estimated to account for 22% of the total in 2000/2001 and is predicted to rise to 63% by 2015/2016.
Conclusions:
Ongoing costs of maintaining implanted children and their implant systems are significant and should be factored into resource-allocation decisions.