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[Pediatric cost-benefit analysis]
H Schulze-Gattermann1, A Illg, A Lesinski-Schiedat
1Dräger Medical AG & Co. KGaA, Lübeck. heide.schulze-gattermann@draeger.com
Insights
Pediatric cochlear implantation offers a favorable cost-benefit ratio compared to hearing aids, especially for children under 2 years old. Early implantation, particularly before age 2, is recommended for prelingually deafened children from a societal perspective.
Area of Science:
- Pediatric audiology and otolaryngology
- Health economics and outcomes research
- Developmental pediatrics
Background:
- Evaluating the cost-benefit ratio of pediatric cochlear implantation (CI) versus hearing aids (HA) for congenital and prelingual deafness.
- Focusing on the payer's perspective to analyze educational and associated costs relative to age at implantation.
Purpose of the Study:
- To compare the cost-benefit ratio of pediatric cochlear implantation with hearing aids in deaf children.
- To verify if educational costs increase with age at implantation and if they can be lower than hearing aid costs.
Main Methods:
- Comparison of four groups: children implanted at 0-1.9 years, 2-3.9 years, 4-6.9 years, and deaf children using hearing aids.
- Analysis from the perspective of sick funds and public authorities, covering medical, indirect, and educational costs up to age 16.
- Educational settings were used as a measure of benefit.
Main Results:
- Total costs for pediatric cochlear implant users ranged from $43,300 to $129,000, while hearing aid users incurred costs of $148,600.
- Educational costs were higher for implanted children in older age groups (4-6.9 years) compared to younger groups, largely due to mainstream schooling.
- Overall societal/payer costs were DM 271,000 (implanted <2 yrs), DM 334,000 (implanted 2-3.9 yrs), DM 348,000 (implanted 4-6.9 yrs) vs. DM 313,000 (hearing aids).
Conclusions:
- Pediatric cochlear implantation demonstrates positive cost-benefit ratios compared to hearing aids, with benefits varying by age at implantation.
- Implantation before age 2 is particularly recommended for prelingually deafened children from a societal/payer viewpoint.
- Implantation between ages 2-3.9 years is educationally justifiable, while later implantations require individualized assessment.
Background:
The aim of this study was to explore the cost-benefit-ratio of pediatric cochlear implantation for congenitally deaf and prelingually deafened children compared to children with hearing aids. The payers' perspective was chosen as this is the most relevant for cost discussions. The study should verify the hypothesis that educational and associated full costs increase with the age at implantation and that these can be below costs for children with hearing aids.
Methods:
Children implanted at different ages (group 1: 0 - 1.9 yr., group 2: 2 - 3.9 yr., group 3: 4 - 6.9 yr.) were compared with deaf children using hearing aids (group 4). Payers were sick funds and public authorities, the first paying for medical and indirect costs, the latter paying for education. Educational settings were used as measure for benefit. All costs related to the hearing deficiency were included up to the age of 16 years (end of primary education) based on 1999 costs.
Results:
Discounted medical and indirect costs for a pediatric cochlear implant user varied between DM 112,000 (53,300 US dollars) and DM 91,000 (43,300 US dollars) depending on the age at implantation. Costs for a hearing aid user added up to DM 36,000 (17,100 US dollars). These costs were paid by the sick funds. Costs for education varied between DM 159,000 (75,700 US dollars) for group 1 and DM 257,000 (122,400 US dollars) for group 3 compared to DM 277,000 (131,900 US dollars) for hearing aid users. These differences are mainly based on the use of mainstream schools. Total costs for sick funds and public authorities ad up to DM 271,000 (129,000 US dollars), DM 334,000 (159,000 US dollars) and DM 348,000 (165,700 US dollars), respectively, for the three age groups of implanted children compared to DM 313,000 (148,600 US dollars) for hearing aid users.
Conclusion:
This study supports the view that pediatric cochlear implantation provides positive cost-benefit ratios compared to hearing aid users depending on the age at implantation. From a societal/payer perspective implantation of prelingually deafened children is especially recommended for children under the age of 2 years. Implantation between ages 2 and 3,9 can be recommended from an educational perspective. Implantation at ages >7 years must be based on individual decisions considering psychosocial environment, speech and language status and type of communication.